| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE SEGAL COMPANY EIN 94-1503999 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $28K |
| UFCW GROUP ADMINISTRATION LLC EIN 26-0048379 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $24K |
| OPTUM RX NONE | Direct payment from the plan; Claims processing Service code 12 | 11000 OPTUM CIRCLE EDEN PRAIRIE, MN 55344 | $18K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $12K |
| DELTA DENTAL PLAN OF ILLINOIS EIN 36-2612058 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $12K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $9K |
| SALTZMAN AND JOHNSON EIN 94-2376174 NONE | Legal; Direct payment from the plan Service code 29 | — | $7K |
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 | 544 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 110 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 654 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | UNITEDHALTHCARE OF CALIFORNIA | 205 | $4.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 748 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Filing reports zero broker compensation on a plan over 100 participants. Likely direct-write or unreported — worth a knock.