| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MESIROW INSURANCE SERVICES INC3 | 353 N CLARK ST STE 1100 CHICAGO, IL 60654 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $9K | — | $9K | 5.00% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INSURANCE SERVICES | 353 NORTH CLARK STREET CHICAGO, IL 60610 | TOKIO MARINE HCC | $6K | — | $6K | 10.00% |
| MESIROW INSURANCE SERVICES INC3 | 353 NORTH CLARK STREET #400 CHICAGO, IL 60654 | EYEMED | $2K | — | $2K | 5.29% |
| LYNN KITSON3 Filed as: LYNN MATTEI | 58053 CRYSTAL SPRINGS DRIVE GOSHEN, IN 46528 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 12.00% |
| MWL3 | PO BOX 14067 JACKSON, MS 39236 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $494 | — | $494 | 2.67% |
| LYNN KITSON3 Filed as: LYNN MATTEI | 58053 CRYSTAL SPRINGS DRIVE GOSHEN, IN 46528 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 12.00% |
| MWL3 | PO BOX 14067 JACKSON, MS 39236 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $473 | — | $473 | 2.61% |
| LYNN KITSON3 Filed as: LYNN MATTEI | 58053 CRYSTAL SPRINGS DRIVE GOSHEN, IN 46528 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $741 | — | $741 | 12.01% |
| MWL3 | PO BOX 14067 JACKSON, MS 39236 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $165 | — | $165 | 2.67% |
| LYNN KITSON3 Filed as: LYNN MATTEI | 58053 CRYSTAL SPRINGS DRIVE GOSHEN, IN 46528 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $683 | — | $683 | 12.00% |
| MWL3 | PO BOX 14067 JACKSON, MS 39236 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $147 | — | $147 | 2.58% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GROUP ADMINISTRATORS, LTD. EIN 36-3381052 NONE | Claims processing Service code 12 | 953 AMERICAN LANE SUITE 100 SCHAUMBURG, IL 60173 | $81K |
| CIGNA CORPORATION EIN 59-1031071 NONE | Other fees Service code 99 | PO BOX 645014 CINCINNATI, OH 45264 | $58K |
| MESIROW INSURANCE SERVICES EIN 36-3429604 NONE | Insurance agents and brokers Service code 22 | 353 NORTH CLARK STREET CHICAGO, IL 60654 | $56K |
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 | 286 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 286 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 241 | $176K |
| Vision | EYEMED | 470 | $31K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 361 | $19K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 360 | $18K |
| Stop-loss / reinsurancereinsurance | US FIRE INSURANCE COMPANY | 286 | $450K |
| Other(3 contracts, 2 carriers) | TOKIO MARINE HCC | 361 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 470 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.