| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NORTH84, LLC3 | 19 CARNABY DR. BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY 3 | $20K | $0 | $20K | 10.00% |
| NORTH84, LLC3 | 19 CARNABY DR. BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY 4 | $10K | $0 | $10K | 10.00% |
| NORTH84, LLC3 | 19 CARNABY DR. BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY 2 | $14K | $0 | $14K | 15.00% |
| NORTH84, LLC3 | 19 CARNABY DR. BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY | $8K | $0 | $8K | 10.00% |
| NORTH84, LLC3 | 19 CARNABY DR. BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY 6 | $4K | $0 | $4K | 10.00% |
| NORTH84, LLC3 | 19 CARNABY DR. BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY 5 | $3K | $0 | $3K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HUMANA INSURANCE COMPANY EIN 39-1263473 TPA | Claims processing; Contract Administrator Service code 12 | — | $279K |
| MILLIAM, INC. EIN 91-0675641 ACTUARIAL | Actuarial Service code 11 | 1120 SOUTH 101ST ST. OMAHA, NE 681241088 | $15K |
| CLIFTON LARSON ALLEN, LLP EIN 41-0746749 AUDITORS | Accounting (including auditing) Service code 10 | 9365 COUNSELORS ROW INDIANAPOLIS, IN 46240 | $0 |
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 | 1,916 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 19 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,935 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY 2 | 845 | $928K |
| Dental | HUMANA INSURANCE COMPANY | 845 | $99K |
| Vision | HUMANA INSURANCE COMPANY | 845 | $99K |
| Life insurance(2 contracts, 2 carriers) | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY 3 | 1,916 | $294K |
| Short-term disability(2 contracts, 2 carriers) | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY | 251 | $124K |
| Long-term disability(2 contracts, 2 carriers) | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY 4 | 223 | $135K |
| Prescription drug | HUMANA INSURANCE COMPANY 2 | 92 | $830K |
| Other(2 contracts, 2 carriers) | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY 3 | 1,916 | $294K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,916 | — |
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.