| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VERITAS RISK SERVICES3 | 1900 SPRING ROAD SUITE 530 OAK BROOK, IL 60523 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $86K | $86K | 5.15% |
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 1900 SPRING ROAD SUITE 530 OAK BROOK, IL 60523 | COMBINED INSURANCE COMPANY OF AMERICA | — | $19K | $19K | 7.93% |
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 1900 SPRING ROAD SUITE 530 OAK BROOK, IL 60523 | COMBINED INSURANCE COMPANY OF AMERICA | — | $11K | $11K | 8.04% |
| VERITAS RISK SERVICES3 | 1900 SPRING ROAD SUITE 530 OAK BROOK, IL 60523 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $603 | $603 | 7.26% |
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 1900 SPRING ROAD SUITE 530 OAK BROOK, IL 60523 | COMBINED INSURANCE COMPANY OF AMERICA | — | $58 | $58 | 7.05% |
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 1900 SPRING ROAD SUITE 530 OAK BROOK, IL 60523 | COMBINED INSURANCE COMPANY OF AMERICA | — | $55 | $55 | 7.88% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTH CARE EIN 41-1321939 NONE | Claims processing Service code 12 | — | $1.3M |
| BLUE CROSS BLUE SHIELD OF IL EIN 36-1236610 NONE | Claims processing Service code 12 | — | $109K |
| DELTA DENTAL OF IL EIN 36-2612058 NONE | Claims processing Service code 12 | — | $92K |
| EXPRESS SCRIPTS EIN 22-3461740 NONE | Claims processing Service code 12 | — | $71K |
| EMPLOYEE RESOURCE CENTER EIN 39-1743189 NONE | Other services Service code 49 | — | $59K |
| TOWERS WATSON EIN 23-1159360 NONE | Actuarial Service code 11 | — | $50K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Trustee (bank, trust company, or similar financial institution); Investment management Service code 21 | — | $48K |
| BENEFIT ADVANTAGE, INC. EIN 39-2023593 NONE | Claims processing Service code 12 | — | $35K |
| HEWITT ENNIS KNUPP EIN 36-3109431 NONE | Consulting (general) Service code 16 | — | $19K |
| SCHENCK SC EIN 39-1173131 NONE | Accounting (including auditing) Service code 10 | — | $12K |
| AETNA EIN 06-6033492 NONE | Insurance services Service code 23 | — | $7K |
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 | 1,747 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,785 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 3,532 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTH GROUP, INC. | 3,532 | $5.7M |
| Vision(4 contracts) | COMBINED INSURANCE COMPANY OF AMERICA | 2,788 | $374K |
| Life insurance | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,532 | $1.7M |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,532 | $1.7M |
| Other | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,830 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,532 | — |
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.