| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EXECUTIVE FIDELITY3 | PO BOX 72668 ROSELLE, IL 601720668 | METROPOLITAN LIFE INSURANCE COMPANY | $9K | — | $9K | 2.20% |
| COMMERCIAL GROUP INTERMEDIARIES3 Filed as: COMMERCIAL GROUP INTERMEDIARIES INC | 16 EXECUTIVE CT STE 4 BARRINGTON, IL 600109528 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 0.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF ILLINOIS EIN 36-1236610 NONE | Other insurance fees and expenses; Claims processing; Contract Administrator Service code 12 | — | $522K |
| ARNOLD & KADJAN EIN 36-2498571 NONE | Legal Service code 29 | — | $248K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Accounting (including auditing) Service code 10 | — | $179K |
| MARY CLAWSON EIN 51-0191061 EMPLOYEE | Employee (plan) Service code 30 | — | $100K |
| DIANA SABAL EIN 51-0191061 EMPLOYEE | Employee (plan) Service code 30 | — | $97K |
| FILOMENA OTTOLINO EIN 51-0191061 EMPLOYEE | Employee (plan) Service code 30 | — | $97K |
| WILLIAM BEEMAN EIN 51-0191061 EMPLOYEE | Plan Administrator; Employee (plan) Service code 14 | — | $93K |
| MARY BETH TYTUS EIN 51-0191061 EMPLOYEE | Employee (plan) Service code 30 | — | $89K |
| ASHLEY STAZAK EIN 51-0191061 EMPLOYEE | Employee (plan) Service code 30 | — | $82K |
| DUANE EXLINE EIN 51-0191061 EMPLOYEE | Employee (plan) Service code 30 | — | $71K |
| JEFFREY NICHOLS EIN 51-0191061 EMPLOYEE | Employee (plan) Service code 30 | — | $60K |
| INNOVATIVE SOFTWARE SOLUTIONS EIN 23-2182079 NONE | Consulting (general); Other services Service code 16 | — | $57K |
| SAVRX PRESCRIPTION SERVICES EIN 47-0527013 NONE | Claims processing Service code 12 | — | $51K |
| GEORGIE SHEPHERD EIN 51-0191061 EMPLOYEE | Employee (plan) Service code 30 | — | $42K |
| MEDICAL COST MANAGEMENT CORP. EIN 36-3445315 NONE | Other services Service code 49 | — | $39K |
| TFBC, LLC EIN 27-3782504 NONE | Actuarial; Consulting (general) Service code 11 | — | $31K |
| AMALGAMATED BANK OF CHICAGO EIN 36-0721895 NONE | Float revenue; Custodial (securities); Investment management; Investment management fees paid directly by plan Service code 19 | — | $23K |
| COMPU-SOLUTIONS, INC. EIN 36-4131525 NONE | Other services Service code 49 | — | $15K |
| NATIONAL INVESTMENT SERVICES NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 777 EAST WISCONSIN AVENUE, STE 2350 MILWAUKEE, WI 53202 | $14K |
| RICHARD J. WOLF & COMPANY EIN 36-3182363 NONE | Accounting (including auditing) Service code 10 | — | $14K |
| MARCO CONSULTING GROUP, INC. EIN 36-3555078 NONE | Investment advisory (plan) Service code 27 | — | $12K |
| ANTONIO ACEVEDO EIN 51-0191061 TRUSTEE | Trustee (individual) Service code 20 | — | $10K |
| JAY LASALA EIN 51-0191061 TRUSTEE | Trustee (individual) Service code 20 | — | $9K |
| ADAM HIGGINS EIN 51-0191061 TRUSTEE | Trustee (individual) Service code 20 | — | $8K |
| SANDRA M. HUNT EIN 51-0191061 TRUSTEE | Trustee (individual) Service code 20 | — | $8K |
| CUNI, RUST & STRENK NONE | Consulting (general); Actuarial Service code 11 | 4555 LAKE FOREST DRIVE 620 CINCINNATI, OH 45242 | $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 | 1,075 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,075 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 1,184 | $427K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 1,184 | $427K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,184 | — |
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.