| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MUTUAL MED INSURANCE SERVICES3 Filed as: MUTUAL MED INSURANCE SVC LLC | 4321 E 60TH ST DAVENPORT, IA 52807 | COVENTRY HEALTH CARE OF IOWA | — | $20K | $20K | 0.76% |
| AMERICAN WESTBROOK INSURANCE | 4 WESTBROOK CORPORATE CENTER #500 WESTCHESTER, IL 60154 | DELTA DENTAL OF ILLINOIS | $16K | — | $16K | 15.00% |
| JAMES K GEORGE3 | 2753 CANTERBURY DRIVE NORTHBROOK, IL 60062 | DELTA DENTAL OF ILLINOIS | $15K | — | $15K | 14.14% |
| AMERICAN WESTBROOK INSURANCE | 4 WESTBROOK CORPORATE CENTER #500 WESTCHESTER, IL 60154 | DELTA DENTAL OF ILLINOIS | $16K | — | $16K | 16.72% |
| JAMES K GEORGE3 | 2753 CANTERBURY DRIVE NORTHBROOK, IL 60062 | DELTA DENTAL OF ILLINOIS | $13K | — | $13K | 14.43% |
| JK GEORGE INC. Filed as: JK GEORGE, INC. | 2753 CANTERBURY DRIVE NORTHBROOK, IL 60062 | PROTEC INSURANCE COMPANY | $1K | — | $1K | 3.35% |
| JK GEORGE INC. | 2753 CANTERBURY DRIVE NORTHBROOK, IL 60062 | PROTEC INSURANCE COMPANY | $705 | — | $705 | 3.35% |
| MUTUAL MED INSURANCE SERVICES3 Filed as: MUTUAL MED INSURANCE SERVICES, LLC | 4321 E 60TH ST DAVENPORT, IA 52807 | COVENTRY HEALTH AND LIFE | — | $9K | $9K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| JEFFREY W KROL & ASSOCIATES, LTD EIN 36-3094368 NONE | Accounting (including auditing); Consulting (general) Service code 10 | — | $62K |
| JAMES MELTREGER EIN 36-6108981 OFFICER | Employee (plan) Service code 30 | — | $50K |
| ANTHONY MONACO EIN 36-6108981 NONE | Employee (plan) Service code 30 | — | $20K |
| VINCENT SENESE EIN 36-6108981 NONE | Employee (plan) Service code 30 | — | $19K |
| THOMAS PARAVOLA EIN 36-0522075 NONE | Legal Service code 29 | — | $18K |
| TAMMY HENRICHS EIN 36-6108981 OFFICER | Employee (plan) Service code 30 | — | $10K |
| JEFFREY PIERUCCI EIN 36-6108981 NONE | Employee (plan) Service code 30 | — | $10K |
| JUAN FERNANDEZ JR. EIN 36-6108981 NONE | Employee (plan) Service code 30 | — | $10K |
| MARY MURPHY EIN 36-6108981 NONE | Employee (plan) Service code 30 | — | $8K |
| FGMK, LLC EIN 36-2929601 NONE | Accounting (including auditing) Service code 10 | — | $5K |
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 | 2,163 | 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) | 2,163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | COVENTRY HEALTH CARE OF IOWA | 0 | $2.6M |
| Dental(4 contracts) | DELTA DENTAL OF ILLINOIS | 192 | $406K |
| Vision(4 contracts) | DELTA DENTAL OF ILLINOIS | 192 | $406K |
| Life insurance(2 contracts) | PROTEC INSURANCE COMPANY | 1,520 | $53K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,520 | — |
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.