| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VERITAS RISK SERVICES | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $30K | — | $30K | 1.53% |
| VERITAS RISK SERVICES | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | KAISER FOUNDATION HEALTH PLANS INC | $27K | — | $27K | 1.73% |
| VERITAS RISK SERVICES | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | UNITED HEALTHCARE INSURANCE COMPANY | $112K | — | $112K | 8.15% |
| VERITAS RISK SERVICES | 3025 HIGHLAND PARKWAY, SUITE 650 DOWNERS GROVE, IL 60515 | KAISER FOUNDATION HEALTH PLANS INC | $8K | — | $8K | 1.64% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $1.9M |
| EXPRESS SCRIPTS EIN 22-3461740 RX BENEFITS PROVIDER | Employee (plan) Service code 30 | — | $149K |
| ICAPS EIN 41-1609779 MEDICAL CLAIMS AUDITOR | Accounting (including auditing) Service code 10 | — | $117K |
| INTERNATIONAL SOS EIN 91-1501877 ER MEDICAL SERVICES | Employee (plan) Service code 30 | — | $47K |
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 | 3,514 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 76 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,590 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | UNITED HEALTHCARE INSURANCE COMPANY | 9,353 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,353 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.