| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UTILITY INSURANCE CO3 | — | SYMETRA LIFE INSURANCE COMPANY | — | $11K | $11K | 2.41% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $6.6M |
| CIGNA EIN 59-1031071 NONE | Other services; Participant communication; Direct payment from the plan; Claims processing; Non-monetary compensation; Float revenue; Contract Administrator Service code 12 | — | $267K |
| WEX, INC. NONE | Direct payment from the plan; Contract Administrator Service code 13 | 1700 E. GOLF ROAD #600 SCHAMBURG, IL 60173 | $183K |
| US BANK NONE | Custodial (other than securities); Direct payment from the plan Service code 18 | 1555 N. RIVERCENTER DR SUITE 300 MILWAUKEE, WI 53212 | $164K |
| FORVIS MAZARS, LLP EIN 44-0160260 NONE | Accounting (including auditing); Foreign entity (e.g., an agent or broker, bank, insurance company, etc. not operating within jurisdictional boundaries of the United States); Direct payment from the plan Service code 10 | — | $77K |
| WILLIS WATSON EIN 26-0775680 NONE | Insurance services; Direct payment from the plan Service code 23 | — | $48K |
| CVS EIN 05-0340626 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $20K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2,408 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,408 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 3,831 | $448K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,831 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.