| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NORTH84, LLC3 | 19 CARNABY DRIVE BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURACE COMPANY | $23K | — | $23K | 10.00% |
| NORTH84, LLC3 | 19 CARNABY DRIVE BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURACE COMPANY | $15K | — | $15K | 10.00% |
| NORTH84, LLC3 | 19 CARNABY DRIVE BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURACE COMPANY | $12K | — | $12K | 10.00% |
| NORTH84, LLC3 | 19 CARNABY DRIVE BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURACE COMPANY | $14K | — | $14K | 15.00% |
| NORTH84, LLC3 | 19 CARNABY DRIVE BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURACE COMPANY | $5K | — | $5K | 10.00% |
| NORTH84, LLC3 | 19 CARNABY DRIVE BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURACE COMPANY | $3K | — | $3K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HUMANA INSURANCE COMPANY EIN 39-1263473 TPA | Claims processing; Contract Administrator Service code 12 | — | $340K |
| MILLIMAN, INC EIN 91-0675641 ACTUARIAL | Actuarial Service code 11 | 1120 SOUTH 101ST STREET OMAHA, NE 681241088 | $53K |
| TASC EIN 46-5661050 TPA | Contract Administrator Service code 13 | PO BOX 88278 MILWAUKEE, WI 532880001 | $11K |
| CLIFTONLARSONALLEN 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 | 1,914 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,920 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY 2 | 1,012 | $1.1M |
| Dental | HUMANA INSURANCE COMPANY | 1,012 | $96K |
| Vision | HUMANA INSURANCE COMPANY | 1,012 | $96K |
| Life insurance(2 contracts) | THE LINCOLN FINANCIAL LIFE INSURACE COMPANY | 1,914 | $318K |
| Short-term disability(2 contracts) | THE LINCOLN FINANCIAL LIFE INSURACE COMPANY | 366 | $144K |
| Long-term disability(2 contracts) | THE LINCOLN FINANCIAL LIFE INSURACE COMPANY | 328 | $197K |
| Prescription drug | HUMANA INSURANCE COMPANY 2 | 93 | $1.0M |
| Other(2 contracts) | THE LINCOLN FINANCIAL LIFE INSURACE COMPANY | 1,914 | $318K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,914 | — |
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."
No prospect flags tripped on this filing.