| 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 | $7K | $4K | $11K | 7.39% |
| MESIROW INSURANCE SERVICES INC3 | 353 N CLARK ST CHICAGO, IL 60654 | TOKIO MARINE HCC | $5K | — | $5K | 10.00% |
| MESIROW INSURANCE SERVICES INC3 | 353 N CLARK ST CHICAGO, IL 60654 | EYEMED | $3K | — | $3K | 9.24% |
| 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 | $518 | — | $518 | 2.61% |
| 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 | $514 | — | $514 | 2.67% |
| LYNN KITSON3 Filed as: LYNN MATTEI | 58053 CRYSTAL SPRINGS DRIVE GOSHEN, IN 46528 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $771 | — | $771 | 12.01% |
| MWL3 | PO BOX 14067 JACKSON, MS 39236 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $172 | — | $172 | 2.68% |
| MWL3 | PO BOX 14067 JACKSON, MS 39236 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $163 | — | $163 | 2.59% |
| LYNN KITSON3 Filed as: LYNN MATTEI | 58053 CRYSTAL SPRINGS DRIVE GOSHEN, IN 46528 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $75 | — | $75 | 1.19% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GROUP ADMINISTRATORS, LTD. EIN 36-3381052 NONE | Claims processing Service code 12 | 953 AMERICAN LANE SUITE 100 SCHAUMBURG, IL 60173 | $70K |
| MESIROW INSURANCE SERVICES EIN 36-3429604 NONE | Insurance agents and brokers Service code 22 | 353 NORTH CLARK STREET CHICAGO, IL 60654 | $61K |
| CIGNA CORPORATION EIN 59-1031071 NONE | Other fees Service code 99 | PO BOX 645014 CINCINNATI, OH 45264 | $57K |
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 | 261 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 261 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | US FIRE INSURANCE COMPANY | 261 | $636K |
| Dental | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 230 | $147K |
| Vision | EYEMED | 468 | $33K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 300 | $19K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 298 | $6K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 298 | $20K |
| Other(2 contracts, 2 carriers) | TOKIO MARINE HCC | 300 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 468 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.