| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 500 WEST MONROE STREET, SUITE 3400 CHICAGO, IL 75703 | BLUECROSS BLUESHIELD OF ILLINOIS | $72K | $4K | $76K | 2.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J GALLAGHER RISK MANAGEMENT | TWO PIERCE PLACE ITASCA, IL 60143 | FEDERAL INSURANCE COMPANY | $941 | $255 | $1K | 19.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH CARE SERVICE CORPORATION EIN 36-1236610 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $250K |
| NORTHERN TRUST COMPANY EIN 36-1561860 CORPORATE TRUSTEE | Trustee (bank, trust company, or similar financial institution); Recordkeeping and information management (computing, tabulating, data processing, etc.); Investment management Service code 15 | — | $69K |
| PLANTE & MORAN PLLC EIN 38-1357951 AUDITOR | Accounting (including auditing) Service code 10 | — | $15K |
| LOCKTON COMPANIES, LLC EIN 20-3354970 ACTUARY | Actuarial Service code 11 | — | $8K |
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 | 218 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 118 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 336 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 720 | $3.8M |
| Dental | BLUECROSS BLUESHIELD OF ILLINOIS | 720 | $3.8M |
| Vision | VISION SERVICE PLAN | 141 | $19K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 260 | $156K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 260 | $156K |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 260 | $166K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 720 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.