| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TEDRICK EMPLOYEE BENEFITS INC3 | 1129 BROADWAY MT. VERNON, IL 62864 | DELTA DENTAL OF ILLINOIS | $8K | — | $8K | 7.63% |
| BAUGHMAN GROUP3 Filed as: BAUGHMAN GROUP INC-GA | — | DELTA DENTAL OF ILLINOIS | — | $2K | $2K | 2.04% |
| TEDRICK EMPLOYEE BENEFITS INC3 | 1129 BROADWAY MT. VERNON, IL 62864 | HARTFORD LIFE AND ACCIDENT | $4K | — | $4K | 10.01% |
| 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 | $2K | — | $2K | 8.69% |
| TEDRICK EMPLOYEE BENEFITS INC3 | 1129 BROADWAY MT. VERNON, IL 62864 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $306 | — | $306 | 1.33% |
| TEDRICK EMPLOYEE BENEFITS INC3 | 1129 BROADWAY MT. VERNON, IL 62864 | VISION SERVICE PLAN | $1K | — | $1K | 5.52% |
| ARK BENEFITS, INC.3 Filed as: ARK BENEFITS INC | 2 CAPILANO HIGHLAND, IL 62249 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $572 | — | $572 | 14.43% |
| TEDRICK EMPLOYEE BENEFITS INC3 | 1129 BROADWAY MT. VERNON, IL 62864 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $62 | — | $62 | 1.56% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $164K |
| TEDRICK EMPLOYEE BENEFITS INC EIN 36-4178615 BROKER | Other commissions Service code 55 | 1129 BROADWAY P.O. BOX 983 MOUNT VERNON, IL 62864 | $54K |
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 | 262 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 262 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF ILLINOIS | 180 | $105K |
| Vision | VISION SERVICE PLAN | 169 | $20K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 278 | $35K |
| Short-term disability(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 50 | $27K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 278 | $35K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 184 | $287K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 278 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 278 | — |
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."
No prospect flags tripped on this filing.