| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AXA ASSISTANCE, USA5 Filed as: AXA ASSISTANCE USA | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $7K | $7K | 0.14% |
| HARVARD PRINTING GROUP5 | 175 US HIGHWAY 46 WEST SUITE 11 FAIRFIELD, NJ 070042327 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $736 | $736 | 0.01% |
| WORTHAM SAN ANTONIO INC7 Filed as: JOHN L WORTHAM & SON LP | PO BOX 301598 DALLAS, TX 75303 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $131K | — | $131K | 4.39% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MERCER (US) INC. EIN 13-2834414 N/A | Plan Administrator; Direct payment from the plan Service code 14 | — | $1.1M |
| HEALTH CARE SERVICE CORPORATION EIN 36-1236610 N/A | Direct payment from the plan; Contract Administrator Service code 13 | — | $900K |
| ENERGY INSURANCE SERVICES EIN 30-0419233 N/A | Direct payment from the plan; Contract Administrator Service code 13 | — | $242K |
| LOOMIS SAYLES & COMPANY EIN 20-8080381 N/A | Direct payment from the plan; Investment management Service code 28 | — | $213K |
| MORGAN STANLEY SMITH BARNEY LLC EIN 26-4310632 N/A | Investment management; Direct payment from the plan Service code 28 | — | $198K |
| ANALYTIC INVESTORS, LLC EIN 95-2665790 N/A | Direct payment from the plan; Investment management Service code 28 | — | $190K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 N/A | Direct payment from the plan; Contract Administrator Service code 13 | — | $166K |
| EXPRESS SCRIPTS EIN 22-3461740 N/A | Direct payment from the plan; Contract Administrator Service code 13 | — | $115K |
| STOEL RIVES EIN 93-0408771 N/A | Legal; Direct payment from the plan Service code 29 | — | $67K |
| HAM, LANGSTON & BREZINA LLP EIN 76-0448495 N/A | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $48K |
| AARP EIN 98-1985500 N/A | Direct payment from the plan; Contract Administrator Service code 13 | — | $19K |
| UNITED BEHAVIORAL HEALTH DBA OPTUM EIN 94-2649097 N/A | Direct payment from the plan; Contract Administrator Service code 13 | — | $13K |
| STATE STREET BANK AND TRUST EIN 04-1867445 N/A | Trustee (directed); Direct payment from the plan; Investment management; Float revenue Service code 25 | — | $7K |
| COMMPSYCH EIN 35-3739783 N/A | Contract Administrator Service code 13 | — | $0 |
| MERCER HEALTH & BENEFITS EIN 34-2015463 N/A | Consulting (general) Service code 16 | — | $0 |
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 | 14,325 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 14,325 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 2,882 | $4.7M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 9,241 | $5.4M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 11,140 | $3.0M |
| Other | CIGNA LIFE INSURANCE CO. OF NEW YORK | 97 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 11,140 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.