| 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 | 0.07% |
| VERITAS RISK SERVICES3 | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $62K | — | $62K | 3.27% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVE., SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $358 | $358 | 0.02% |
| VERITAS RISK SERVICES3 | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | HUMANA INSURANCE COMPANY | $44K | — | $44K | 5.10% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | PO BOX 28852 LOCKBOX 28852 NEW YORK, NY 100878852 | HUMANA INSURANCE COMPANY | $1K | — | $1K | 0.16% |
| VERITAS RISK SERVICES3 | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | EYE MED | — | $309 | $309 | 8.24% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| 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 | $41K |
| COMPSYCH EIN 35-3739783 | 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 | 1,157 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 263 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,420 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH CARE SERVICE CORPORATION | 1,005 | $7.5M |
| Vision | EYE MED | 27 | $4K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,420 | $1.9M |
| Prescription drug | HUMANA INSURANCE COMPANY | 415 | $857K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,420 | — |
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.