| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SKODINSKI INSURANCE LLC3 | 2212 LINCOLN WAY W. MISHAWAKA, IN 46544 | HUMANA INSURANCE COMPANY | $56K | — | $56K | 4.53% |
| SKODINSKI INSURANCE LLC3 | 2212 LINCOLN WAY W. MISHAWAKA, IN 465441617 | HUMANA INSURANCE COMPANY | $3K | — | $3K | 4.21% |
| SKODINSKI INSURANCE LLC3 | 2212 LINCOLN WAY W. MISHAWAK, IN 465441617 | HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC. | $2K | — | $2K | 4.14% |
| SKODINSKI INSURANCE LLC3 | 2212 LINCOLN WAY W. MISHAWAKA, IN 46544 | HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC. | $450 | — | $450 | 4.26% |
| SKODINSKI INSURANCE LLC3 | 2212 LINCOLN WAY W. MISHAWAKA, IN 46544 | HUMANA BENEFIT PLAN OF ILLINOIS, INC. | $300 | — | $300 | 4.14% |
| BENESYS INC5 Filed as: BENESYS, INC. | 700 TOWER DRIVE, SUITE 300 TROY, MI 48098 | HUMANA INSURANCE COMPANY | $22K | — | $22K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE CO. EIN 35-0781558 NONE | Direct payment from the plan; Contract Administrator; Claims processing; Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $289K |
| BENESYS, INC. EIN 38-2383171 NONE | Claims processing; Direct payment from the plan; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $198K |
| TIC INTERNATIONAL CORPORATION EIN 13-2600875 NONE | Plan Administrator; Contract Administrator; Direct payment from the plan; Accounting (including auditing); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 10 | — | $110K |
| IU HEALTH OCCUPATIONAL SERVICES EIN 26-3975368 NONE | Direct payment from the plan; Other services Service code 49 | — | $36K |
| BENDA, GRACE, STULZ & COMPANY PC EIN 38-2284921 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $17K |
| CHEIRON, INC. EIN 13-4215617 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $12K |
| DELAWARE INVESTMENTS NONE | Investment management; Direct payment from the plan Service code 28 | 2005 MARKET STREET PHILADELPHIA, PA 19103 | $12K |
| URDA PROFESSIONAL CORPORATION EIN 35-6269273 NONE | Legal; Direct payment from the plan Service code 29 | — | $7K |
| MORGAN STANLEY SMITH BARNEY LLC EIN 26-4310632 NONE | Direct payment from the plan; Investment advisory (plan); Other investment fees and expenses Service code 27 | — | $5K |
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 | 803 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 288 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,091 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Prescription drug | HUMANA INSURANCE COMPANY | 959 | $0 |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | UNION LABOR LIFE INSURANCE COMPANY | 803 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 959 | — |
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."
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.