| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EMPYREAN INSURANCE SERVICES, INC.3 Filed as: EMPYREAN INSURANCE SERVICES, INC | 9009 WEST LOOP S, SUITE 600 HOUSTON, TX 77096 | RELIASTAR LIFE INSURANCE COMPANY | — | $62K | $62K | 1.56% |
| LOCKTON COMPANIES, LLC3 | 500 W. MONROE STREET, SUITE 3400 CHICAGO, IL 60661 | RELIASTAR LIFE INSURANCE COMPANY | $9K | — | $9K | 0.23% |
| DAVID M. BANET & ASSOCIATES3 | 45 DOWLIN FORGE ROAD EXTON, PA 19341 | KEYSTONE | $141K | $18K | $159K | 4.79% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF ILLINOIS EIN 36-1236610 MEDICAL ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $4.5M |
| EXPRESS SCRIPTS, INC. EIN 43-1420563 RX ADMINISTRATOR | Contract Administrator Service code 13 | — | $634K |
| DELTA DENTAL OF ILLINOIS EIN 36-2612058 DENTAL ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $232K |
| VISION SERVICE PLAN EIN 20-0891619 ADMINISTRATOR | Contract Administrator Service code 13 | — | $161K |
| COMPSYCH EIN 36-3739783 EAP ADMINISTRATOR | Contract Administrator Service code 13 | — | $148K |
| BLUE CROSS BLUE SHIELD OF GEORGIA EIN 58-1638390 MEDICAL ADMINISTRATOR | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Other fees; Other services Service code 12 | — | $89K |
| LOCKTON COMPANIES, LLC BROKER | Insurance agents and brokers Service code 22 | 500 W. MONROE ST,3400 CHICAGO, IL 60661 | $25K |
| BLUE CROSS AND BLUE SHIELD OF GEORG EIN 58-0469845 MEDICAL ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Other services; Contract Administrator Service code 12 | — | $23K |
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 | 11,398 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 11,398 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 789 | $11.4M |
| Vision | VISION SERVICE PLAN | 7,910 | $1.2M |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 11,398 | $4.0M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 11,376 | $2.3M |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 54 | $705K |
| Other(2 contracts, 2 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 11,398 | $4.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 11,398 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.