| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON US, LLC | PO BOX 28852 NEW YORK, NY 10087 | HEALTH CARE SERVICE CORPORATION | $41K | $2K | $42K | 0.51% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON US, LLC | PO BOX 28852 NEW YORK, NY 10087 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $24K | — | $24K | 1.57% |
| RIGGS COUNSELMAN MICHAELS & DOWNES3 | PO BOX 74608 CLEVELAND, OH 441940691 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 0.10% |
| IMG5 | 2960 N MERIDIAN ST INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $151 | $151 | 0.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | PO BOX 28852 LOCKBOX 28852 NEW YORK, NY 100878852 | HUMANA INSURANCE COMPANY | $44K | — | $44K | 6.02% |
| VERITAS RISK SERVICES3 | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | EYE MED | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRUDENTIAL INS COMPANY OF AMERICA EIN 22-1211670 THIRD PARTY ADMINISTRATOR | Plan Administrator; Contract Administrator Service code 13 | — | $91K |
| 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 | 1,388 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 173 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,561 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH CARE SERVICE CORPORATION | 1,561 | $9.1M |
| Vision | EYE MED | 31 | $3K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,561 | $1.5M |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,561 | $1.5M |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,561 | $1.5M |
| Prescription drug | HUMANA INSURANCE COMPANY | 406 | $725K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,561 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,561 | — |
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.