| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NORTH84, LLC3 | 19 CARNABY DR BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY | $24K | — | $24K | 10.00% |
| NORTH84, LLC3 | 19 CARNABY DR BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY | $14K | — | $14K | 10.00% |
| NORTH84, LLC3 | 19 CARNABY DR BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY | $18K | — | $18K | 15.00% |
| NORTH84, LLC3 | 19 CARNABY DR BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY | $11K | — | $11K | 10.00% |
| NORTH84, LLC3 | 19 CARNABY DR BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY | $10K | — | $10K | 10.00% |
| NORTH84, LLC3 | 19 CARNABY DR BROWNSBURG, IN 46112 | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HUMANA INSURANCE COMPANY EIN 39-1263473 TPA | Claims processing; Contract Administrator Service code 12 | — | $415K |
| MILLIMAN, INC EIN 91-0675641 ACTUARY | Actuarial Service code 11 | 1120 SOUTH 101ST STREET OMAHA, NE 681241088 | $31K |
| EVERYTHING BENEFITS EIN 46-5072394 TPA | Contract Administrator Service code 13 | 1253 SPRINGFIELD AVE NEW PROVIDENCE, NJ 07974 | $14K |
| PROSPECTIVE RISK MANAGEMENT LLC EIN 20-4770398 ACTUARY | Actuarial Service code 11 | 4348 SOUTHPOINT BLVD JACKSONVILLE, FL 32216 | $13K |
| TASC EIN 46-5661050 TPA | Contract Administrator Service code 13 | PO BOX 88278 MILWAUKEE, WI 532880001 | $9K |
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 | 2,027 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 15 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,042 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA INSURANCE COMPANY | 66 | $855K |
| Vision | HUMANA INSURANCE COMPANY | 1,155 | $113K |
| Life insurance(2 contracts) | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY | 2,027 | $357K |
| Short-term disability(2 contracts) | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY | 398 | $174K |
| Long-term disability(2 contracts) | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY | 409 | $210K |
| Prescription drug | HUMANA INSURANCE COMPANY | 66 | $855K |
| Other(2 contracts) | THE LINCOLN FINANCIAL LIFE INSURANCE COMPANY | 2,027 | $357K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,027 | — |
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.