| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TEDRICK EMPLOYEE BENEFITS INC3 Filed as: TEDRICK EMPLOYEE BENEFITS INC. | — | DELTA DENTAL OF ILLINOIS | $7K | — | $7K | 7.52% |
| BAUGHMAN GROUP3 Filed as: BAUGHMAN GROUP INC-GA | — | DELTA DENTAL OF ILLINOIS | — | $2K | $2K | 2.00% |
| TEDRICK EMPLOYEE BENEFITS INC3 Filed as: TEDRICK EMPLOYEE BENEFITS INC. | PO BOX 848 MOUNT VERNON, IL 62864 | HARTFORD LIFE AND ACCIDENT | $3K | — | $3K | 9.30% |
| ARK BENEFITS, INC.3 Filed as: ARK BENEFITS INC. | 2 CAPILANO HIGHLAND, IL 62249 | HARTFORD LIFE AND ACCIDENT | -$3 | — | -$3 | -0.01% |
| ARK BENEFITS, INC.3 Filed as: ARK BENEFITS INC | 2 CAPILANO HIGHLAND, IL 62249 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 11.22% |
| TEDRICK EMPLOYEE BENEFITS INC3 Filed as: TEDRICK EMPLOYEE BENEFITS INC. | PO BOX 983 MOUNT VERNON, IL 62864 | VISION SERVICE PLAN | $1K | — | $1K | 5.81% |
| ARK BENEFITS, INC. Filed as: ARK BENEFITS INC | 2 CAPILANO HIGHLAND, IL 62249 | UNUM LIFE INUSRANCE COMPANY OF AMERICA | $2K | — | $2K | 27.23% |
| TEDRICK EMPLOYEE BENEFITS INC3 Filed as: TEDRICK EMPLOYEE BENEFITS INC. | 1129 BROADWAY MT. VERNON, IL 62864 | UNUM LIFE INUSRANCE COMPANY OF AMERICA | $4 | — | $4 | 0.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $138K |
| TEDRICK EMPLOYEE BENEFITS, INC. EIN 36-4178615 BROKER | Other commissions Service code 55 | — | $50K |
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 | 249 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 249 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF ILLINOIS | 160 | $93K |
| Vision | VISION SERVICE PLAN | 154 | $18K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 242 | $30K |
| Short-term disability(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 84 | $32K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 242 | $30K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 171 | $235K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 242 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 242 | — |
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.