| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COMMERCIAL GROUP INTERMEDIARIES3 | 16 EXECUTIVE COURT, STE. 4 SOUTH BARRINGTON, IL 60010 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $17K | — | $17K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CATAMARAN INC. EIN 75-2578509 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $244K |
| BLUECROSS BLUE SHIELD OF ILLINOIS EIN 36-1236610 NONE | Claims processing; Other insurance fees and expenses Service code 12 | — | $170K |
| BENEFITS MANAGEMENT GROUP, INC. EIN 84-1677167 NONE | Contract Administrator Service code 13 | — | $69K |
| BRENDAN BERIGAN NONE | Consulting (general) Service code 16 | 8608 HORTON CIRCLE URBANDALE, IA 50322 | $30K |
| DAY RETTIG PEIFFER EIN 42-1386412 NONE | Legal Service code 29 | — | $29K |
| HEALTHCARE STRATEGIES EIN 52-1874471 NONE | Contract Administrator Service code 13 | — | $21K |
| LWBJ, LLP EIN 42-1462849 NONE | Accounting (including auditing) Service code 10 | 4200 UNIVERSITY AVE, SUITE 410 WEST DES MOINES, IA 50266 | $18K |
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 | 224 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 224 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 225 | $338K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 225 | — |
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.