| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MESIROW INSURANCE SERVICES INC3 | 353 N CLARK ST STE 1100 CHICAGO, IL 60610 | BLUECROSS BLUESHIELD OF ILLINOIS | $57K | $3K | $60K | 4.10% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INSURANCE SERVICE | 353 N CLARK ST STE 1100 CHICAGO, IL 60610 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 10.00% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INSURANCE SERVICE | 353 N CLARK ST STE 1100 CHICAGO, IL 60610 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INSURANCE SERVICE | 353 N CLARK ST STE 1100 CHICAGO, IL 60610 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 10.00% |
| MESIROW INSURANCE SERVICES INC3 | 353 N CLARK ST STE 1100 CHICAGO, IL 60610 | DELTA DENTAL OF ILLINOIS | $5K | — | $5K | 42.66% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INSURANCE SERVICE | 353 N CLARK ST STE 1100 CHICAGO, IL 60610 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $450 | — | $450 | 10.00% |
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 | 162 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 162 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 301 | $1.5M |
| Dental | DELTA DENTAL OF ILLINOIS | 129 | $11K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 193 | $40K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 64 | $15K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 98 | $20K |
| Prescription drug | BLUECROSS BLUESHIELD OF ILLINOIS | 301 | $1.5M |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 167 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 301 | — |
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.