| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY3 | 333 W 34TH STREET NEW YORK, NY 10001 | THE UNION LABOR LIFE INSURANCE COMPANY | — | $10K | $10K | 1.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 NONE | Contract Administrator; Other services; Float revenue; Claims processing; Non-monetary compensation; Named fiduciary; Participant communication; Direct payment from the plan Service code 12 | — | $768K |
| BENESYS INC EIN 38-2383171 NONE | Copying and duplicating; Contract Administrator Service code 13 | — | $672K |
| THE SEGAL COMPANY EIN 94-1503999 NONE | Accounting (including auditing); Insurance agents and brokers Service code 10 | — | $264K |
| KAY PRINTING NONE | Other services; Copying and duplicating Service code 36 | 220 ENTIN RD CLIFTON, NJ 07014 | $91K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 NONE | Plan Administrator; Claims processing Service code 12 | — | $77K |
| US BANK TRUST CO EIN 93-6157747 NONE | Custodial (securities) Service code 19 | — | $64K |
| SALTZMAN & JOHNSON NONE | Legal Service code 29 | 7 W. 41ST AVENUE STE 410 SAN MATEO, CA 94403 | $51K |
| EVERNORTH BEHAVIORAL HEALTH EIN 41-1648670 NONE | Claims processing; Direct payment from the plan; Participant communication; Contract Administrator Service code 12 | — | $49K |
| GALLAGHER FIDUCIARY ADVISORS LLC EIN 36-4291971 NONE | Investment advisory (plan) Service code 27 | — | $30K |
| SEGAL SELECT INSURANCE EIN 46-0169194 NONE | Insurance services Service code 23 | — | $27K |
| HEALTH EQUITY EIN 52-2383166 NONE | Insurance services; Contract Administrator Service code 13 | — | $24K |
| BALDWIN MOFFITT BEHM LLP EIN 46-4370753 NONE | Accounting (including auditing) Service code 10 | — | $16K |
| IRON MOUNTAIN NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 929 S MEDINA ST SAN ANTONIO, TX 78207 | $13K |
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 | 1,868 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,868 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 1,868 | $806K |
| Dental | DELTA DENTAL INSURANCE COMPANY | 1,868 | $1.7M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,868 | $1.4M |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 1,868 | $519K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,868 | — |
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.