| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEYSTONE INSURANCE & BENEFITS GROUP3 Filed as: KEYSTONE INSURANCE & BENEFITS | 13800 JACKSON RD MISHAWAKA, IN 46544 | BLUECROSS BLUESHIELD OF ILLINOIS | $42K | $2K | $44K | 3.50% |
| ASSUREDPARTNERS3 Filed as: DIMOND BROS INSURANCE | P.O. BOX 1090 PARIS, IL 61944 | BLUECROSS BLUESHIELD OF ILLINOIS | $4K | — | $4K | 0.33% |
| KEYSTONE INSURANCE & BENEFITS GROUP3 Filed as: KEYSTONE INSURANCE | 13800 JACKSON RD MISHAWAKA, IN 46544 | BLUECROSS BLUESHIELD OF ILLINOIS | $9K | — | $9K | 9.31% |
| KARRI A MCRIGHT3 | 5509 BELMONT RD STE B DOWNERS GROVE, IL 60515 | BLUECROSS BLUESHIELD OF ILLINOIS | $412 | — | $412 | 0.44% |
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 | 156 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 154 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 312 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 212 | $1.3M |
| Dental | BLUECROSS BLUESHIELD OF ILLINOIS | 212 | $1.3M |
| Vision | BLUECROSS BLUESHIELD OF ILLINOIS | 159 | $94K |
| Life insurance | BLUECROSS BLUESHIELD OF ILLINOIS | 159 | $94K |
| Short-term disability | BLUECROSS BLUESHIELD OF ILLINOIS | 159 | $94K |
| Other | BLUECROSS BLUESHIELD OF ILLINOIS | 159 | $94K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 212 | — |
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.