| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RELATION INSURANCE INC3 Filed as: RELATION INS. SVS. GREAT LAKES INC. | 7 MEDINAH ROAD MEDINAH, IL 60157 | BLUECROSS BLUESHIELD OF ILLINOIS | $54K | $0 | $54K | 3.94% |
| KAMM INSURANCE GROUP3 Filed as: KAMM INSURANCE GROUP, INC. | UNKNOWN CHICAGO, IL 60661 | BLUECROSS BLUESHIELD OF ILLINOIS | $0 | $720 | $720 | 0.05% |
| RELATION INSURANCE INC3 Filed as: RELATION INS. SVS. GREAT LAKES INC. | 7 MEDINAH ROAD MEDINAH, IL 60157 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | $0 | $8K | 6.75% |
| RELATION INSURANCE SERVICES OF CA3 Filed as: RELATION INSURANCE SERVICES, INC. | 520 CAPITAL MALL, SUITE 500 SACRAMENTO, CA 95815 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $0 | $9K | 14.16% |
| RELATION INSURANCE SERVICES OF CA3 Filed as: RELATION INSURANCE SERVICES, INC. | 2290 HUNTINGTON DRIVE, SUITE 200 SAN MARINO, CA 91108 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $1K | $1K | 1.85% |
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 | 126 | 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) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 191 | $1.4M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 195 | $116K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 195 | $116K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $66K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $66K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 126 | $66K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 195 | $183K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 195 | — |
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.