| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENICO LTD3 | 11715 E MAIN ST PO BOX 8 HUNTLEY, IL 60142 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $96K | $19K | $115K | 10.14% |
| THE BENEFIT COMPANY INC Filed as: BENEFIT ADVISORS LLC | 680 HAWTHORNE AVE #140 SALEM, OR 97301 | UNIAMERICA INSURANCE COMPANY | $3K | — | $3K | 0.40% |
| BENICO LTD3 | 11715 E MAIN ST PO BOX 8 HUNTLEY, IL 60142 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $49K | $13K | $62K | 7.66% |
| BENICO LTD3 | 11715 E MAIN ST HUNTLEY, IL 60142 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $39K | $13K | $52K | 6.65% |
| JOHN P GARVEN3 | 11715 E MAIN ST HUNTLEY, IL 60142 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $2K | — | $2K | 2.67% |
| BENICO LTD3 | 11715 E MAIN ST PO BOX 8 HUNTLEY, IL 60142 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $565 | $2K | 6.67% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK BLUE SHIELD EIN 23-1294723 THIRD PARTY ADMINIATRATOR | Plan Administrator Service code 14 | PO BOX 890173 CAMP HILL, PA 17089 | $1.6M |
| DELTA DENTAL OF PENNSYLVANIA EIN 23-1667011 THIRD PARTY ADMINISTRATOR | Plan Administrator Service code 14 | ONE DELTA DR MECHANICSBURG, PA 17055 | $126K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 THIRD PARTY ADMINIATRATOR | Plan Administrator Service code 14 | PO BOX 997330 SACRAMENTO, CA 95899 | $36K |
| INTERFLEX PAYMENTS, LLC EIN 27-2256926 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 2508 HIGHLANDER WAY, STE 200 CARROLLTON, TX 75006 | $18K |
| DAVIS VISION EIN 11-3051991 THIRD PARTY ADMINISTRATOR | Plan Administrator Service code 14 | 175 E HOUSTON ST SAN ANTONIO, TX 78205 | $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 | 3,192 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 21 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,213 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $1.1M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $775K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $813K |
| Other(2 contracts, 2 carriers) | UNIAMERICA INSURANCE COMPANY | 2,962 | $861K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,962 | — |
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.