| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEMENS & ASSOC LIFE AGENCY LTD3 | 2806 E. EMPIRE ST. BLOOMINGTON, IL 617012228 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $0 | $22K | $22K | 0.11% |
| CLEMENS & ASSOC LIFE AGENCY LTD3 | 2806 E. EMPIRE ST. BLOOMINGTON, IL 61704 | BLUE CROSS BLUE SHIELD DENTAL | $0 | $15K | $15K | 1.70% |
| CLEMENS & ASSOC LIFE AGENCY LTD3 | 2806 E. EMPIRE ST. BLOOMINGTON, IL 61704 | DEARBORN NATIONAL | $12K | $0 | $12K | 1.58% |
| STUMM INSURANCE LLC3 | 9400 W HIGGINS RD. SUITE 310 ROSEMONT, IL 60018 | DEARBORN NATIONAL | $0 | $10K | $10K | 1.30% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CLEMENS & ASSOCIATES LIFE AGENCY EIN 37-1075738 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $130K |
| ILLINOIS BANKERS ASSOCIATION EIN 36-3215107 PLAN ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $106K |
| GIFFIN, WINNING, COHEN & BODEWES PC EIN 37-1105961 NONE | Legal; Direct payment from the plan Service code 29 | — | $21K |
| KERBER, ECK & BRAECKEL EIN 43-0352985 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $20K |
| GREAT LAKES ADVISORS EIN 80-0292839 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $19K |
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 | 1,660 | 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) | 1,660 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 1,850 | $20.3M |
| Dental | BLUE CROSS BLUE SHIELD DENTAL | 1,912 | $871K |
| Vision | DEARBORN NATIONAL | 1,163 | $748K |
| Life insurance | DEARBORN NATIONAL | 1,163 | $748K |
| Short-term disability | DEARBORN NATIONAL | 1,163 | $748K |
| Long-term disability | DEARBORN NATIONAL | 1,163 | $748K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ILLINOIS | 1,850 | $20.3M |
| Other | DEARBORN NATIONAL | 1,163 | $748K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,912 | — |
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.