| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MESIROW INSURANCE SERVICES INC3 | 353 N. CLARK ST CHICAGO, IL 60654 | CIGNA HEALTH AND LIFE INS. CO | $36K | $3K | $38K | 10.71% |
| MESIROW INSURANCE SERVICES INC3 | 353 N CLARK ST CHICAGO, IL 606544704 | DELTA DENTAL OF ILLINOIS | $2K | — | $2K | 3.67% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INSURANCE SERVICES INC. | 353 N. CLARK ST. CHICAGO, IL 60654 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $651 | $3K | 20.84% |
| ALG ACQUISITIONS I LLC3 | 2650 MCCORMICK DRIVE CLEARWATER, FL 33759 | ALLSTATE BENEFITS | $727 | — | $727 | 5.07% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INSURANCE SERVICES INC. | 353 N. CLARK ST CHICAGO, IL 60654 | ALLSTATE BENEFITS | $332 | — | $332 | 2.32% |
| ERIC FRIBRUSH3 | 9722 GROFFS MILL DR OWINGS, MD 21117 | ALLSTATE BENEFITS | $244 | — | $244 | 1.70% |
| EDWIN MANUEL VELASQUEZ3 Filed as: EDWIN M. VELASQUEZ | 33013 SEVILLE STREET LAKE ELSINORE, CA 92530 | ALLSTATE BENEFITS | $33 | — | $33 | 0.23% |
| DEBBIE M BRADY3 Filed as: DEBBIE M. BRADY | 250 S. ROSE DR SPC 21 PLACENTA, CA 92870 | ALLSTATE BENEFITS | $4 | — | $4 | 0.03% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW FINANCIAL | 353 NORTH CLARK STREET SUITE 1100 CHICAGO, IL 60654 | EYEMED VISION CARE | $968 | — | $968 | 9.90% |
| MESIROW INSURANCE SERVICES INC3 | 353 N. CLARK ST. CHICAGO, IL 60654 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $273 | $1K | 19.00% |
| MESIROW INSURANCE SERVICES INC3 | 353 N. CLARK ST CHICAGO, IL 60654 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $310 | $37 | $347 | 16.77% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS. CO. EIN 59-1031071 N/A | Non-monetary compensation; Direct payment from the plan; Named fiduciary; Contract Administrator; Claims processing; Participant communication; Float revenue; Other services Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $39K |
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 | 165 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INS. CO | 135 | $376K |
| Dental | DELTA DENTAL OF ILLINOIS | 117 | $64K |
| Vision | EYEMED VISION CARE | 153 | $10K |
| Life insurance(3 contracts, 2 carriers) | ALLSTATE BENEFITS | 167 | $23K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 60 | $16K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INS. CO | 135 | $357K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 167 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 167 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.