| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDUCATIONAL & INSTITUTIONAL INS ADM3 Filed as: EDUCATIONAL & INSTITIONAL INS. ADM | 200 S WACKER DR SUITE 1000 CHICAGO, IL 60606 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | — | $5K | 1.83% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ILLINOIS INC | 233 S WACKER DR STE 2000 CHICAGO, IL 60606 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $2K | $2K | 0.81% |
| EDUCATIONAL & INSTITUTIONAL INS ADM3 | 200 SOUTH WACKER DRIVE SUITE 1000 CHICAGO, IL 60606 | DELTA DENTAL OF ILLINOIS | $2K | — | $2K | 2.12% |
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL STREET BOSTON, MA 02110 | DELTA DENTAL OF ILLINOIS | $2K | — | $2K | 2.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 16219 COLLECTIONS CENTER DRIVE CHICAGO, IL 60693 | DELTA DENTAL OF ILLINOIS | $697 | — | $697 | 0.81% |
| NONE3 | — | VISION SERVICE PLAN | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $132K |
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 | 288 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 292 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF ILLINOIS | 163 | $86K |
| Vision | VISION SERVICE PLAN | 106 | $15K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 288 | $56K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 250 | $300K |
| Other | HARTFORD LIFE AND ACCIDENT | 288 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 288 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.