| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JEFF HALSETH5 | COASTAL PLAINS INSURANCE 15 BOW CIRCLE HILTON HEAD, SC 29928 | MONUMENTAL LIFE INSURANCE COMPANY | $678 | — | $678 | 1.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF IL EIN 36-1236610 PARTY-IN-INTEREST | Contract Administrator; Claims processing Service code 12 | — | $6.3M |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 PARTY-IN-INTEREST | Contract Administrator Service code 13 | — | $5.5M |
| MEDCO HEALTH SOLUTIONS EIN 22-3461740 PARTY-IN-INTEREST | Claims processing; Contract Administrator Service code 12 | — | $3.4M |
| VALUE OPTIONS EIN 54-1414194 PARTY-IN-INTEREST | Claims processing Service code 12 | — | $233K |
| VISION SERVICE PLAN EIN 91-6056925 PARTY-IN-INTEREST | Claims processing Service code 12 | — | $128K |
| CARENA PARTY-IN-INTEREST | Claims processing Service code 12 | P.O. BOX 673 SEATTLE, WA 98111 | $88K |
| PLANTE & MORAN, PLLC EIN 38-1357951 PARTY-IN-INTEREST | Accounting (including auditing) Service code 10 | — | $85K |
| CIGNA EIN 95-3310115 PARTY-IN-INTEREST | Claims processing; Contract Administrator Service code 12 | — | $18K |
| JPMORGAN CHASE BANK EIN 13-4994650 TRUSTEE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $7K |
| THE BOEING CO AND CONSOLIDATED SUBS EIN 91-0425694 PLAN SPONSOR | Plan Administrator Service code 14 | — | $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 | 36,109 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 36,109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(13 contracts, 13 carriers) | COVENTRY HEALTH CARE OF KANSAS INC | 1,538 | $41.4M |
| Vision(9 contracts, 9 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. CA | 884 | $7.0M |
| Prescription drug(12 contracts, 12 carriers) | GROUP HEALTH COOPERATIVE | 954 | $24.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,538 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.