| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MESIROW INSURANCE SERVICES INC3 | — | BLUECROSS BLUESHIELD OF ILLINOIS | $48K | $2K | $50K | 1.75% |
| ALLIANT INSURANCE SERVICES, INC.3 | — | BLUECROSS BLUESHIELD OF ILLINOIS | $16K | — | $16K | 0.56% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MESIROW INSURANCE SERVICES IN | 353 NORTH CLARK CHICAGO, IL 60654 | BLUECROSS BLUESHIELD OF ILLINOIS | — | $8 | $8 | 0.00% |
| INTERPARK, LLC3 | 200 NORTH LASALLE STREET SUITE 400 CHICAGO, IL 60601 | BLUECROSS BLUESHIELD OF ILLINOIS | — | $5 | $5 | 0.00% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1050 WILSHIRE DRIVE SUITE 210 TROY, MI 48084 | BLUECROSS BLUESHIELD OF ILLINOIS | — | $1 | $1 | 0.00% |
| ALLIANT INSURANCE SERVICES, INC.3 | 1050 WILSHIRE DRIVE SUITE 210 TROY, MI 48084 | BLUECROSS BLUESHIELD OF ILLINOIS | — | $1 | $1 | 0.00% |
| MESIROW INSURANCE SERVICES INC3 | 353 NORTH CLARK STREET SUITE 1100 CHICAGO, IL 60654 | DEARBORN LIFE INSURANCE COMPANY | $10K | — | $10K | 5.35% |
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 | 250 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 251 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 339 | $2.9M |
| Dental | AETNA LIFE INSURANCE CO. | 60 | $14K |
| Vision(2 contracts) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 334 | $28K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 250 | $190K |
| Long-term disability | DEARBORN LIFE INSURANCE COMPANY | 250 | $190K |
| Other(2 contracts, 2 carriers) | DEARBORN LIFE INSURANCE COMPANY | 250 | $190K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 339 | — |
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.