| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLOOM HEALTH INSURANCE AGENCY LLC3 Filed as: BLOOM HEALTH INSURANCE AGENCY | 15 S 5TH ST STE 300 MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $588 | — | $588 | 4.07% |
| AON CONSULTING INC3 Filed as: AON CONSULTING- CHICAGO | PO BOX 905494 CHARLOTTE, NC 282905494 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $368 | $368 | 2.55% |
| BLOOM HEALTH INSURANCE AGENCY LLC3 Filed as: BLOOM HEALTH CORPORATION-EXCHANGE | 15 SOUTH 5TH ST, STE 300 MINNEAPOLIS, MN 55402 | EYEMED VISION CARE | $410 | — | $410 | 3.16% |
| BLOOM HEALTH INSURANCE AGENCY LLC3 Filed as: BLOOM HEALTH INSURANCE AGENCY | 15 S 5TH ST STE 300 MINNEAPOLIS, MN 55402 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $20 | — | $20 | 12.27% |
| AON CONSULTING INC3 Filed as: AON CONSULTING- CHICAGO | PO BOX 905494 CHARLOTTE, NC 282905494 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | — | $12 | $12 | 7.36% |
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 | 176 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 188 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 341 | $2.4M |
| Dental | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | 3 | $163 |
| Vision(2 contracts) | EYEMED VISION CARE | 303 | $13K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 113 | $14K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 113 | $14K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 113 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 341 | — |
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.
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.