| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 1900 SPRING ROAD SUITE 530 OAK BROOK, IL 60523 | COMBINED INSURANCE COMPANY OF AMERICA | — | $12K | $12K | 7.93% |
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 1900 SPRING ROAD SUITE 530 OAK BROOK, IL 60523 | COMBINED INSURANCE COMPANY OF AMERICA | — | $7K | $7K | 8.04% |
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 1900 SPRING ROAD SUITE 530 OAK BROOK, IL 60523 | COMBINED INSURANCE COMPANY OF AMERICA | — | $42 | $42 | 7.01% |
| VERITAS RISK SERVICES3 Filed as: VERITAS RISK SERVICES, LLC | 1900 SPRING ROAD SUITE 530 OAK BROOK, IL 60523 | COMBINED INSURANCE COMPANY OF AMERICA | — | $36 | $36 | 7.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITEDHEALTH GROUP, INC. EIN 41-1321939 NONE | Claims processing Service code 12 | — | $948K |
| DELTA DENTAL OF IL EIN 36-2612058 NONE | Claims processing Service code 12 | — | $86K |
| BLUE CROSS BLUE SHIELD OF IL EIN 36-1236610 NONE | Claims processing Service code 12 | — | $84K |
| EMPLOYEE RESOURCE CENTER EIN 39-1743189 NONE | Other services Service code 49 | — | $61K |
| EXPRESS SCRIPTS EIN 22-3461740 NONE | Claims processing Service code 12 | — | $61K |
| TOWERS WATSON EIN 23-1159360 NONE | Actuarial Service code 11 | — | $25K |
| BENEFIT ADVANTAGE,INC. EIN 39-2023593 NONE | Claims processing Service code 12 | — | $15K |
| SCHENCK SC EIN 39-1173131 NONE | Accounting (including auditing) Service code 10 | — | $11K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $8K |
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 | 1,343 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 643 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 1,986 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTH GROUP, INC. | 654 | $1.9M |
| Vision(4 contracts) | COMBINED INSURANCE COMPANY OF AMERICA | 1,856 | $247K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,856 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.