| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: PACIFIC RESOURCES BENEFITS ADVISORS | FAINA GITMAN STE 635 21300 VICTORY BLVD WOODLAND HILLS, CA 91367 | MINNESOTA LIFE INSURANCE COMPANY | — | $129K | $129K | 2.22% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 06-0303370 NONE | Direct payment from the plan; Contract Administrator; Claims processing; Float revenue; Participant communication Service code 12 | — | $1.2M |
| FIDELITY INSTITUTIONAL EIN 04-2647786 NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 13 | — | $795K |
| CAREMARK EIN 95-3382344 NONE | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $186K |
| CIGNA BEHAVIORIAL HEALTH INC. EIN 41-1648670 NONE | Contract Administrator; Participant communication; Direct payment from the plan; Claims processing Service code 12 | — | $134K |
| CROWE HORWATH LLP EIN 35-0921680 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $59K |
| WESTERN ASSET MANAGEMENT EIN 95-2705797 NONE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $14K |
| SSGA WILSHIRE EIN 04-6927789 NONE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $9K |
| MELLON BANK EIN 25-0659306 NONE | Investment advisory (participants); Direct payment from the plan Service code 26 | — | $9K |
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 | 6,029 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 6,029 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | MINNESOTA LIFE INSURANCE COMPANY | 4,707 | $5.8M |
| Other | MINNESOTA LIFE INSURANCE COMPANY | 4,707 | $5.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,707 | — |
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.