| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COMMERCIAL GROUP INTERMEDIARIES3 | 2356 HASSELL ROAD, SUITE F HOFFMAN ESTATES, IL 60169 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $20K | — | $20K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUE SHIELD OF ILLINOIS EIN 36-1236610 NONE | Claims processing; Other insurance fees and expenses Service code 12 | — | $216K |
| BENEFITS MANAGEMENT GROUP, INC. EIN 84-1677167 NONE | Contract Administrator Service code 13 | — | $168K |
| HEALTHCARE STRATEGIES EIN 52-1874471 NONE | Contract Administrator Service code 13 | — | $34K |
| BRENDAN BERIGAN NONE | Consulting (general) Service code 16 | 8608 HORTON CIRCLE URBANDALE, IA 50322 | $33K |
| DAY RETTIG MARTIN, P.C. EIN 42-1386412 NONE | Legal Service code 29 | — | $27K |
| LWBJ, LLP EIN 42-1462849 NONE | Accounting (including auditing) Service code 10 | 4200 UNIVERSITY AVE, SUITE 410 WEST DES MOINES, IA 50266 | $18K |
| CEDAR RAPIDS BANK & TRUST NONE | Custodial (securities) Service code 19 | 500 1ST AVE NE, STE 100 CEDAR RAPIDS, IA 52401 | $15K |
| OPTUMRX PHARMACY NONE | Claims processing Service code 12 | 5070 ROCKWELL DR NE CEDAR RAPIDS, IA 52402 | $8K |
| RICHARD L. TALLMAN NONE | Accounting (including auditing) Service code 10 | 2515 UNIVERSITY BLVD, SUITE 101 AMES, IA 50010 | $8K |
| DENTAL NETWORK OF AMERICA NONE | Other insurance fees and expenses Service code 73 | 701 E 22ND ST 300 LOMBARD, IL 60148 | $7K |
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 | 368 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 368 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 365 | $391K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 365 | — |
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.