| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EBCG LLC3 | 2205 LAKESIDE DR. BANNOCKBURN, IL 600151265 | METROPOLITAN LIFE INSURANCE COMPANY | $54K | $73K | $127K | 2.75% |
| CONDUENT HR CONSULTING LLC3 | PO BOX 202617 DALLAS, TX 75320 | HEALTH ALLIANCE PLAN | $154K | — | $154K | 5.34% |
| CONDUENT HR CONSULTING LLC3 | PO BOX 202617 DALLAS, TX 753202617 | DELAWARE AMERICAN LIFE INSURANCE COMPANY | $55K | — | $55K | 9.79% |
| EBCG LLC3 | 2205 LAKESIDE DR. BANNOCKBURN, IL 60015 | SUN LIFE ASSURANCE COMPANY OF CANADA | $52K | — | $52K | 15.39% |
| EBCG LLC3 | PO BOX 1702 RUTHERFORD, NJ 07070 | HYATT LEGAL PLANS | $3K | — | $3K | 6.75% |
| EBCG LLC3 | 2205 LAKESIDE DR BANNOCKBURN, IL 60015 | HYATT LEGAL PLANS | $2K | — | $2K | 3.32% |
| BUCK CONSULTANTS LLC3 | PO BOX 202617 DALLAS, TX 75320 | HYATT LEGAL PLANS | — | $135 | $135 | 0.29% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 ADMIN SVC PROVIDER | Other services; Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $4.4M |
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 | 2,323 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 25 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,348 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH ALLIANCE PLAN | 533 | $3.4M |
| Dental | DELAWARE AMERICAN LIFE INSURANCE COMPANY | 33 | $561K |
| Vision(2 contracts, 2 carriers) | DELAWARE AMERICAN LIFE INSURANCE COMPANY | 4,913 | $797K |
| Life insurance(2 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 11,528 | $5.2M |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 11,528 | $4.6M |
| Other(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 11,528 | $5.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 11,528 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.