| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KAMM INSURANCE GROUP3 | 7N024 MEDINAH RD PO BOX 129 MEDINAH, IL 60157 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $110K | $5K | $115K | 2.12% |
| MYERS-BRIGGS & CO3 | 300 S WACKER DR STE 1000 CHICAGO, IL 60606 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | — | $13K | 3.80% |
| MYERS-BRIGGS & CO3 | 300 WACKER DRIVE STE 1000 CHICAGO, IL 60606 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $15K | — | $15K | 15.00% |
| KAMM INSURANCE GROUP3 | 7N024 MEDINAH RD PO BOX 129 MEDINAH, IL 60157 | PROTEC INSURANCE CO. | $7K | — | $7K | 100.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF ILLINOIS EIN 36-1236610 ADMINISTRATOR | Contract Administrator Service code 13 | 300 EAST RANDOLPH STREET CHICAGO, IL 60601 | $532K |
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 | 1,381 | 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 | 1,381 | $5.4M |
| Dental | DELTA DENTAL | 649 | $29K |
| Vision | PROTEC INSURANCE CO. | 664 | $7K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 331 | $103K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 746 | $346K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 746 | $346K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,381 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.