| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | COM LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | MINNESOTA LIFE INSURANCE COMPANY | — | $33K | $33K | 2.27% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPYREAN BENEFIT SOLUTIONS EIN 20-3029813 PARTY-IN-INTEREST | Participant communication; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $265K |
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 PARTY-IN-INTEREST | Consulting (general); Claims processing; Other fees; Other services; Contract Administrator; Direct payment from the plan; Participant communication; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $223K |
| WILLIS TOWERS WATSON EIN 26-0775680 PARTY-IN-INTEREST | Plan Administrator; Claims processing; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Participant communication Service code 12 | — | $76K |
| BOKF, NA DBA BANK OF OKLAHOMA EIN 73-0780382 PARTY-IN-INTEREST | Investment management; Trustee (discretionary); Trustee (bank, trust company, or similar financial institution); Other fees; Distribution (12b-1) fees; Named fiduciary; Investment management fees paid indirectly by plan; Trustee (directed); Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Investment advisory (plan); Shareholder servicing fees Service code 15 | — | $33K |
| HOGANTAYLOR LLP EIN 73-1413977 PARTY-IN-INTEREST | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $11K |
| UNITED BEHAVIORAL HEALTH DBA OPTUM EIN 94-2649097 PARTY-IN-INTEREST | Direct payment from the plan; Other fees; Other services; Plan Administrator; Claims processing Service code 12 | — | $6K |
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 | 4,248 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 111 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,359 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | MINNESOTA LIFE INSURANCE COMPANY | 4,026 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,026 | — |
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.