| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP, INC. | 580 N BANK LANE SUITE 101 LAKE FOREST, IL 60045 | BCBS OF NEBRASKA | $38K | — | $38K | 4.49% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP, INC. | 580 N BANK LANE LAKE FOREST, IL 60045 | GUARDIAN | $4K | $3K | $7K | 16.23% |
| MARK PIETSCH3 | 10816 CRYSTAL SPRINGS LANE ORLAND, IL 60457 | GUARDIAN | $42 | — | $42 | 0.10% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP | 580 N BANK LANE LAKE FOREST, IL 60045 | UNUM LIFE INSURANCE CO | $2K | $92 | $2K | 16.57% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP, INC. | 580 N BANK LANE, STE 101 LAKE FOREST, IL 60045 | EYEMED VISION CARE | $745 | — | $745 | 7.57% |
| MIDLANDS FINANCIAL BENEFITS3 | 7101 S 82ND ST LINCOLN, NE 68516 | PROVIDENT LIFE AND ACCIDENT INS CO | $157 | — | $157 | 1.85% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP | 580 N BANK LANE LAKE FOREST, IL 60045 | PROVIDENT LIFE AND ACCIDENT INS CO | $21 | — | $21 | 0.25% |
| FOREST HILLS FINANCIAL GROUP3 Filed as: FOREST FINANCAIL GROUP INC | 580 N BANK LANE LAKE FOREST, IL 60045 | UNUM LIFE INSURANCE CO | $533 | $40 | $573 | 11.40% |
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 | 182 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 184 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BCBS OF NEBRASKA | 157 | $838K |
| Dental | GUARDIAN | 85 | $42K |
| Vision | EYEMED VISION CARE | 130 | $10K |
| Life insurance | UNUM LIFE INSURANCE CO | 182 | $5K |
| Long-term disability | UNUM LIFE INSURANCE CO | 19 | $12K |
| Other(2 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INS CO | 182 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 182 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.