| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLMARK INC3 | PO BOX 10481 DES MOINES, IA 50306 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $355 | — | $355 | 1.13% |
| WELLMARK INC3 | PO BOX 10481 DES MOINES, IA 50306 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $795 | — | $795 | 3.75% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 NONE | Claims processing; Contract Administrator Service code 12 | — | $3.6M |
| MERCER HEALTH AND BENEFITS EIN 20-1932099 NONE | Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $908K |
| ACTIVE HEALTH MANAGEMENT EIN 52-2182411 NONE | Participant communication; Consulting (general) Service code 16 | — | $199K |
| AETNA BEHAVIORAL HEALTH, LLC EIN 20-0446713 NONE | Plan Administrator Service code 14 | — | $147K |
| PAYFLEX EIN 91-1774434 NONE | Claims processing Service code 12 | — | $100K |
| BNY MELLON TRUST COMPANY EIN 95-3571558 NONE | Investment management; Trustee (directed) Service code 25 | — | $56K |
| JONES WALKER EIN 72-0445111 NONE | Legal Service code 29 | — | $36K |
| WEAVER EIN 75-0786316 NONE | Accounting (including auditing) Service code 10 | — | $36K |
| FIDELITY INVESTMENTS INSTITUTIONAL EIN 04-2647786 NONE | Plan Administrator Service code 14 | — | $31K |
| AETNA INC. EIN 23-2229683 NONE | Contract Administrator Service code 13 | — | $27K |
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 | 4,679 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,563 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 6,242 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA INTERNATIONAL | 723 | $6.3M |
| Dental | AETNA INTERNATIONAL | 723 | $5.6M |
| Vision(2 contracts, 2 carriers) | AETNA INTERNATIONAL | 3,010 | $6.1M |
| Life insurance(2 contracts) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 63 | $52K |
| Short-term disability(2 contracts) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 63 | $52K |
| Long-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 32 | $21K |
| Prescription drug(2 contracts, 2 carriers) | AETNA INTERNATIONAL | 723 | $6.3M |
| Other(3 contracts, 2 carriers) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 63 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,010 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.