| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP INC. | 580 N BANK LANE SUITE 101 LAKE FOREST, IL 60045 | BLUE CROSS BLUE SHIELD | $61K | — | $61K | 3.58% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP INC. | 580 N BANK LANE SUITE 101 LAKE FOREST, IL 60045 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 10.00% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP INC. | 580 N BANK LANE SUITE 101 LAKE FOREST, IL 60045 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP INC. | 580 N BANK LANE SUITE 101 LAKE FOREST, IL 60045 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP INC. | 580 N BANK LANE SUITE 101 LAKE FOREST, IL 60045 | EYE MED | $2K | — | $2K | 9.96% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP INC. | 580 N BANK LANE SUITE 101 LAKE FOREST, IL 60045 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $600 | — | $600 | 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 | 212 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 214 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD | 268 | $1.7M |
| Dental | BLUE CROSS BLUE SHIELD | 268 | $1.7M |
| Vision | EYE MED | 225 | $16K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 98 | $35K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 233 | $32K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 233 | $25K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 301 | $6K |
| 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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.