| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MESIROW INSURANCE SERVICES INC3 | 353 NORTH CLARK STREET CHICAGO, IL 60654 | BLUECROSS BLUESHIELD OF ILLINOIS | $70K | $3K | $73K | 4.05% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: LAMBENT RISK MANAGEMENT SERVICES | 141 WEST JACKSON BOULEVARD SUITE 502 CHICAGO, IL 60654 | PRINCIPAL LIFE INSURANCE COMPANY | $20K | $0 | $20K | 7.31% |
| MESIROW INSURANCE SERVICES INC3 | 353 NORTH CLARK STREET CHICAGO, CA 60654 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | $2K | $6K | 2.05% |
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B STREET, 6TH FLOOR SAN DIEGO, CA 92101 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 0.38% |
| MESIROW INSURANCE SERVICES INC3 | 353 NORTH CLARK STREET, SUITE 1100 CHICAGO, CA 60654 | VISION SERVICE PLAN | $840 | $0 | $840 | 2.71% |
| ALLIANT INSURANCE SERVICES, INC.3 | PO BOX 8299 PASADENA, CA 91109 | VISION SERVICE PLAN | $715 | $0 | $715 | 2.30% |
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 | 250 | 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) | 250 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 323 | $1.8M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 343 | $275K |
| Vision | VISION SERVICE PLAN | 190 | $31K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 343 | $275K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 343 | $275K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 343 | $275K |
| Prescription drug | BLUECROSS BLUESHIELD OF ILLINOIS | 323 | $1.8M |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 343 | $280K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 343 | — |
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.