| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC4 Filed as: USI INSRUANCE SERVICES LLC | PO BOX 62819 VIRGINIA BEACH, VA 234662819 | PRINCIPAL LIFE INSURANCE COMPANY | $29K | — | $29K | 4.63% |
| CORESOURCE, INC.3 Filed as: CORESOURCE | 655 METRO PL S STE 700 DUBLIN, OH 430173661 | VISION SERVICE PLAN | $51K | — | $51K | 8.29% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA - PPO EIN 59-1031071 NONE | Other services; Claims processing Service code 12 | — | $723K |
| VISION SERVICE PLAN EIN 06-1227840 NONE | Claims processing Service code 12 | — | $647K |
| AETNA - PPO EIN 06-6033492 NONE | Claims processing; Other services Service code 12 | — | $351K |
| MULTIPLAN EIN 43-6004435 NONE | Plan Administrator; Other services; Claims processing Service code 12 | — | $164K |
| CHANGE HEALTHCARE EIN 20-5716594 NONE | Claims processing; Other services Service code 12 | — | $114K |
| AUSTIN PRINT SOLUTIONS EIN 56-1730685 NONE | Other services; Direct payment from the plan; Copying and duplicating Service code 36 | — | $110K |
| LOCKTON INVESTMENT ADVISORS, LLC EIN 20-8874282 | Other services; Consulting (general); Direct payment from the plan Service code 16 | — | $100K |
| DIXON HUGHES GOODMAN, LLP EIN 56-0747981 ACCOUNTANT | Accounting (including auditing) Service code 10 | — | $22K |
| ACS - A XEROX COMPANY EIN 36-4129784 NONE | Other services; Claims processing Service code 12 | — | $17K |
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 | 8,247 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 50 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 8,297 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN, INC | 635 | $4.4M |
| Vision | VISION SERVICE PLAN | 5,292 | $619K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 8,072 | $631K |
| Stop-loss / reinsurancereinsurance | AETNA LIFE INSURANCE COMPANY | 7,362 | $677K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,072 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.