| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VERITAS RISK SERVICES3 | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | HEALTH CARE SERVICE CORPORATION | $5K | — | $5K | 0.09% |
| VERITAS RISK SERVICES3 | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $55K | — | $55K | 3.64% |
| VERITAS RISK SERVICES3 | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 0.39% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVE., SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $355 | $355 | 0.02% |
| VERITAS RISK SERVICES3 | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | HUMANA INSURANCE COMPANY | $23K | — | $23K | 2.35% |
| VERITAS RISK SERVICES3 | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | VISION SERVICE PLAN | $119 | $1K | $1K | 19.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CHARLES SCHWAB EIN 34-1479833 TRUSTEE | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $340K |
| HCSC, MUTUAL LEGAL RESERVE CO. EIN 36-1236610 CONTRACT ADMINISTRATOR | Claims processing; Insurance brokerage commissions and fees; Direct payment from the plan Service code 12 | 300 E RANDOLPH ST. CHICAGO, IL 60601 | $334K |
| PRUDENTIAL INS COMPANY OF AMERICA EIN 22-1211670 THIRD PARTY ADMIN FEES | Contract Administrator; Plan Administrator Service code 13 | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | $40K |
| COMPSYCH EIN 35-3739783 THIRD PARTY ADMIN FEES | Contract Administrator Service code 13 | 455 N CITYFRONT PLAZA DR CHICAGO, IL 60611 | $0 |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,120 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 260 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,380 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH CARE SERVICE CORPORATION | 968 | $6.7M |
| Vision | VISION SERVICE PLAN | 32 | $6K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,380 | $1.5M |
| Prescription drug | HUMANA INSURANCE COMPANY | 412 | $962K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,380 | — |
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."
No prospect flags tripped on this filing.