| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARY WHITT COBALT BENEFITS, INC.3 | 22615 STATE ROAD 120 ELKHART, IN 465165369 | COMPANION LIFE INSURANCE | $70K | $0 | $70K | 10.00% |
| PROFESSIONAL BENEFIT ADMINISTRATORS5 | 900 JORIE BLVD OAK BROOK, IL 60523 | COMPANION LIFE INSURANCE | $35K | $0 | $35K | 5.00% |
| MARY WHITT COBALT BENEFITS, INC.3 | 22615 STATE ROAD 120 ELKHART, IN 465165369 | UNITED HEALTHCARE INSURANCE COMPANY | $7K | $0 | $7K | 10.00% |
| MARY WHITT COBALT BENEFITS, INC.3 | 22615 STATE ROAD 120 ELKHART, IN 465165369 | VISION SERVICE PLAN | $2K | $0 | $2K | 3.50% |
| MARY WHITT COBALT BENEFITS, INC.3 | 22615 STATE ROAD 120 ELKHART, IN 465165369 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 11.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PROFESSIONAL BENEFIT ADMINISTRATORS EIN 36-3384135 THIRD PARTY ADMINISTRATO | Claims processing; Contract Administrator Service code 12 | 900 JORIE BLVD OAK BROOK, IL 60523 | $240K |
| MCGLADREY LLP EIN 42-0714325 ACCOUNTANT | Accounting (including auditing) Service code 10 | 52700 INDEPENDENCE COURT P.O. BOX 99 ELKHART, IN 46515 | $19K |
| NEW AVENUES, INC. EIN 35-2095998 EAP | Other services Service code 49 | P.O. BOX 360 SOUTH BEND, IN 46624 | $6K |
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 | 436 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 439 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMPANION LIFE INSURANCE | 439 | $700K |
| Vision | VISION SERVICE PLAN | 312 | $56K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 122 | $51K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 122 | $51K |
| Prescription drug | COMPANION LIFE INSURANCE | 439 | $700K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE | 439 | $700K |
| Other(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 122 | $117K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 439 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.