| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENNIE INSURANCE, LLC3 | 700 CANAL STREET, SUITE 1 STAMFORD, CT 06902 | BLUECROSS BLUESHIELD OF ILLINOIS | $60K | $0 | $60K | 4.07% |
| BENNIE INSURANCE, LLC3 | 700 CANAL STREET, SUITE 1 STAMFORD, CT 06902 | DEARBORN LIFE INSURANCE COMPANY | $4K | $0 | $4K | 12.34% |
| MUTUAL MED INSURANCE SERVICES3 Filed as: MUTUAL MED INSURANCE SERVICES, LLC | 4321 EAST 60TH STREET DAVENPORT, IA 52807 | DEARBORN LIFE INSURANCE COMPANY | $0 | $952 | $952 | 2.66% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE & FINANCIAL | 4851 LYNDON B. JOHNSON FREEWAY SUITE 100 DALLAS, TX 75244 | DEARBORN LIFE INSURANCE COMPANY | $0 | $838 | $838 | 2.34% |
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 | 124 | 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) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 188 | $1.5M |
| Dental | BLUECROSS BLUESHIELD OF ILLINOIS | 188 | $1.5M |
| Vision | DEARBORN LIFE INSURANCE COMPANY | 148 | $36K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 148 | $36K |
| Prescription drug | BLUECROSS BLUESHIELD OF ILLINOIS | 188 | $1.5M |
| Other | DEARBORN LIFE INSURANCE COMPANY | 148 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 188 | — |
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.