| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SKODINSKI INSURANCE LLC3 | 2212 LINCOLN WAY WEST MISHAWAKA, IN 46544 | HUMANA INSURANCE COMPANY | $111K | — | $111K | 8.21% |
| MACQUEEN & ASSOCIATES LLC3 | 2191 TWELVE MILE ROAD BERKLEY, MI 48072 | UNION LABOR LIFE INSURANCE COMPANY | $40K | — | $40K | 8.00% |
| SKODINSKI INSURANCE LLC3 | 2212 LINCOLN WAY W MISHAWAKA, IN 46544 | HUMANA BENEFIT PLAN OF ILLINOIS, INC. | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE CO. EIN 35-0781558 NONE | Claims processing; Contract Administrator; Direct payment from the plan; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $562K |
| ACTIVATE HEALTHCARE LLC NONE | Direct payment from the plan; Other services Service code 49 | 9302 N MERIDIAN, STE 385 INDIANAPOLIS, IN 46260 | $479K |
| BENESYS, INC. EIN 38-2383171 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | — | $278K |
| EVERSIDE HEALTH, LLC EIN 45-3449075 NONE | Direct payment from the plan; Other services Service code 49 | — | $252K |
| TIC INTERNATIONAL CORPORATION EIN 13-2600875 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Accounting (including auditing); Direct payment from the plan; Plan Administrator Service code 10 | — | $125K |
| NEW AVENUES, INC NONE | Other services; Direct payment from the plan Service code 49 | PO BOX 360 SOUTH BEND, IN 46624 | $28K |
| SCREENSAFE, INC NONE | Direct payment from the plan; Other services Service code 49 | 2708 CATON FARM RD JOLIET, IL 60435 | $22K |
| MACQUIRE INVESTMENT MGMT NONE | Investment management; Direct payment from the plan Service code 28 | 2005 MARKET STREET PHILADELPHIA, PA 19103 | $21K |
| BENDA, GRACE, STULZ & COMPANY, P.C. EIN 38-2284921 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $20K |
| SEMMA HEALTH NONE | Direct payment from the plan; Consulting (general) Service code 16 | 100 E WAYNE ST, STE 400 SOUTH BEND, IN 46601 | $18K |
| FOSTER & FOSTER NONE | Consulting (general); Direct payment from the plan Service code 16 | 184 SHUMAN, BLVD, STE 305 NAPERVILLE, IL 60563 | $15K |
| URDA PROFESSIONAL CORPORATION EIN 35-6269273 NONE | Legal; Direct payment from the plan Service code 29 | — | $13K |
| MORGAN STANLEY SMITH BARNEY LLC EIN 26-4310632 NONE | Other investment fees and expenses; Direct payment from the plan; Investment advisory (plan) 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 | 989 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 318 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,307 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | UNION LABOR LIFE INSURANCE COMPANY | 1,047 | $495K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,047 | — |
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.