| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MID AMERICAN GROUP, INC.3 Filed as: MID AMERICAN GROUP INC | 760 PASQUINELLINI DR STE 358 WESTMONT, IL 60559 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $39K | $3K | $42K | 4.15% |
| MID AMERICAN GROUP, INC.3 Filed as: MID AMERICAN GROUP INC | 760 PASQUINELLINI DR STE 358 WESTMONT, IL 60559 | AMERITAS | $7K | $85 | $7K | 10.12% |
| MID AMERICAN GROUP, INC.3 Filed as: MID AMERICAN GROUP INC | 760 PASQUINELLINI DR STE 358 WESTMONT, IL 60559 | MUTUAL OF OMAHA INSURANCE COMPANY | $4K | $1K | $5K | 10.04% |
| AXION RMS LTD | 2651 WARRENVILLE ROAD SUITE 200 DOWNERS GROVE, IL 60515 | MUTUAL OF OMAHA INSURANCE COMPANY | $1K | — | $1K | 2.60% |
| MID AMERICAN GROUP, INC.3 Filed as: MID AMERICAN GROUP INC | 760 PASQUINELLINI DR STE 358 WESTMONT, IL 60559 | EYEMED VISION CARE | $970 | — | $970 | 9.92% |
No Schedule C service providers reported on this filing.
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 | 132 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 231 | $1.0M |
| Dental | AMERITAS | 246 | $70K |
| Vision | EYEMED VISION CARE | 178 | $10K |
| Life insurance | MUTUAL OF OMAHA INSURANCE COMPANY | 132 | $50K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 132 | $50K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 132 | $50K |
| Other | MUTUAL OF OMAHA INSURANCE COMPANY | 132 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 246 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.