| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOUGLAS TRUAX3 | 3025 HIGHLAND PARKWAY DOWNERS GROVE, IL 60515 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $39K | $4K | $43K | 1.95% |
| SHARON SCHLENKER3 | 3025 HIGHLAND PARKWAY DOWNERS GROVE, IL 60515 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $308 | — | $308 | 0.01% |
| SHARON SCHLENKER3 | 3025 HIGHLAND PARKWAY STE 650 DOWNERS GROVE, IL 60515 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $0 | $0 | 0.00% |
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 3025 HIGHLAND PARKWAY, STE 650 DOWNERS GROVE, IL 60515 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $53K | $0 | $53K | 5.94% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $56 | $56 | 0.01% |
| NATIONAL BENEFIT CONSULTANTS, INC.3 | 208 E OAK CREST DRIVE WALES, WI 53183 | UNITED AMERICAN INSURANCE COMPANY | $20K | $0 | $20K | 11.61% |
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 3025 HIGHLAND PARKWAY, STE 650 DOWNERS GROVE, IL 60515 | DELTA DENTAL OF MICHIGAN | $7K | $0 | $7K | 4.37% |
| NATIONAL BENEFITS CONSULTANTS, INC.3 | 208 E OAK CREST DRIVE WALES, WI 53183 | EXPRESS SCRIPTS, INC | $3K | $0 | $3K | 2.05% |
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 3025 HIGHLAND PARKWAY, STE 650 DOWNERS GROVE, IL 60515 | EYEMED VISION CARE | $2K | $0 | $2K | 7.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TOWERS WATSON INVESTMENT SVC INC EIN 52-1868818 NONE | Investment management; Securities brokerage; Investment management fees paid directly by plan; Direct payment from the plan Service code 28 | — | $81K |
| STATE STREET BANK AND TRUST EIN 04-1867445 NONE | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $69K |
| TOWERS WATSON DELAWARE INC. EIN 53-0181291 NONE | Investment management; Investment management fees paid directly by plan; Securities brokerage Service code 28 | — | $36K |
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 | 163 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 323 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 490 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 538 | $3.3M |
| Dental | DELTA DENTAL OF MICHIGAN | 521 | $165K |
| Vision | EYEMED VISION CARE | 577 | $30K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 383 | $886K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 383 | $886K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 383 | $886K |
| Prescription drug(3 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 538 | $3.3M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 383 | $891K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 577 | — |
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.