| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEMENS & ASSOC LIFE AGENCY LTD3 | 2806 E. EMPIRE ST. BLOOMINGTON, IL 61704 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $0 | $21K | $21K | 0.11% |
| CLEMENS & ASSOC LIFE AGENCY LTD3 | 2806 E. EMPIRE ST. BLOOMINGTON, IL 61704 | BLUE CROSS BLUE SHIELD DENTAL | $0 | $2K | $2K | 0.09% |
| CLEMENS & ASSOC LIFE AGENCY LTD3 | 2806 E. EMPIRE ST. BLOOMINGTON, IL 61704 | DEARBORN NATIONAL | $12K | $5K | $17K | 1.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ILLINOIS BANKERS ASSOCIATION EIN 36-3215107 PLAN ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $146K |
| CLEMENS & ASSOCIATES LIFE AGENCY EIN 37-1075738 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $130K |
| GIFFEN, WINNING, COHEN & BODEWES PC EIN 37-1105961 NONE | Legal; Direct payment from the plan Service code 29 | — | $33K |
| GREAT LAKES ADVISORS NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | 231 SOUTH LASALLE ST, 4TH FLR CHICAGO, IL 60604 | $19K |
| ESTES, BRIDGEWATER & OGDEN EIN 37-0265152 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $7K |
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 | 1,817 | 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) | 1,817 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 2,125 | $18.5M |
| Dental | BLUE CROSS BLUE SHIELD DENTAL | 2,055 | $1.9M |
| Vision | DEARBORN NATIONAL | 1,318 | $837K |
| Life insurance | DEARBORN NATIONAL | 1,318 | $837K |
| Short-term disability | DEARBORN NATIONAL | 1,318 | $837K |
| Long-term disability | DEARBORN NATIONAL | 1,318 | $837K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ILLINOIS | 2,125 | $18.5M |
| Other | DEARBORN NATIONAL | 1,318 | $837K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,125 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.