| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MESIROW INSURANCE SERVICES INC3 | 353 N CLARK ST STE 1100 CHICAGO, IL 60654 | BLUECROSS BLUESHIELD OF ILLINOIS | $60K | $3K | $63K | 4.12% |
| MESIROW INSURANCE SERVICES INC3 | 353 N CLARK ST STE 1100 CHICAGO, IL 60654 | DEARBORN LIFE INSURANCE COMPANY | $13K | $5K | $18K | 18.49% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES | 5444 WESTHEIMER RD STE 800 HOUSTON, TX 77056 | DEARBORN LIFE INSURANCE COMPANY | $14 | — | $14 | 0.01% |
| MESIROW INSURANCE SERVICES INC3 Filed as: MEISROW INSURANCE SERVICES INC | 353 NORTH CLARK STREET STE 1100 CHICAGO, IL 60654 | UNITEDHEALTHCARE INSURANCE COMPANY | $4K | — | $4K | 4.45% |
| MESIROW INSURANCE SERVICES INC3 | 353 N CLARK ST CHICAGO, IL 60654 | AMERITAS LIFE INSURANCE CORP. | $2K | — | $2K | 4.08% |
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET SAN DIEGO, CA 92101 | EYEMED VISION CARE | $962 | — | $962 | 6.97% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT EMPLOYEE BENEFITS-GLEN ALLE | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | EYEMED VISION CARE | $209 | — | $209 | 1.51% |
| MESIROW INSURANCE SERVICES INC3 | 353 N CLARK ST #400 CHICAGO, IL 60654 | EYEMED VISION CARE | $106 | — | $106 | 0.77% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GROUP ADMINISTRATORS, LTD EIN 36-3381052 CLAIMS PROCESSING | Claims processing Service code 12 | — | $4K |
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Contract Administrator; Claims processing Service code 12 | — | $3K |
| ALLIANT INSURANCE SERVICES INS AGENTS AND BROKERS | Insurance agents and brokers Service code 22 | 353 N CLARK ST FLOOR 10 CHICAGO, IL 60654 | $88 |
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 | 201 | 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) | 201 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF ILLINOIS | 256 | $1.6M |
| Dental | AMERITAS LIFE INSURANCE CORP. | 149 | $40K |
| Vision | EYEMED VISION CARE | 191 | $14K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 186 | $99K |
| Short-term disability | DEARBORN LIFE INSURANCE COMPANY | 186 | $99K |
| Long-term disability | DEARBORN LIFE INSURANCE COMPANY | 186 | $99K |
| Other | DEARBORN LIFE INSURANCE COMPANY | 186 | $99K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 256 | — |
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.