| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FOREST FINANCIAL GROUP INC3 | 580 N BANK LANE LAKE FOREST, IL 60045 | AETNA LIFE INSURANCE CO | $108K | — | $108K | 1.87% |
| LEBHERZ INSURANCE SERVICES INC3 Filed as: LEBHERZ INS SERV INC | 1600 WEST HILLSDALE BLVD SAN MATEO, CA 94402 | AETNA LIFE INSURANCE CO | $78K | — | $78K | 1.35% |
| NICHOLAS THOMAS GIALAMAS3 Filed as: NICHOLAS GIALAMAS | 580 N BANK LANE LAKE FOREST, IL 60045 | KAISER FOUNDATION HEALTH PLAN INC | $65K | — | $65K | 4.52% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP, INC | 580 N BANK LANE LAKE FOREST, IL 60045 | AETNA HEALTH INC | $13K | $18K | $31K | 4.38% |
| LEBHERZ INSURANCE SERVICES INC3 Filed as: LEBHERZ INSURANCE SERVICES, INC | 1600 WEST HILLSDALE BLVD SAN MATEO, CA 94402 | AETNA HEALTH INC | $10K | — | $10K | 1.35% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP, INC | 580 N BANK LANE LAKE FOREST, IL 60045 | UNUM LIFE INSURANCE CO | $58K | $3K | $61K | 15.48% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP, INC | 580 N BANK LN, STE 101 LAKE FOREST, IL 60045 | VISION SERVICE PLAN | $3K | — | $3K | 2.60% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP | 580 N BANK LANE, STE 101 LAKE FOREST, IL 60045 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $305 | $3K | 18.71% |
| NICHOLAS THOMAS GIALAMAS3 Filed as: NICHOLAS T GIALAMAS | 1207 BURR OAK RD LAKE FOREST, IL 60045 | FIRST UNUM LIFE INSURANCE CO | $78 | — | $78 | 14.94% |
| NICHOLAS THOMAS GIALAMAS3 Filed as: NICHOLAS T. GIALAMAS | 580 N BANK LANE, STE 101 LAKE FOREST, IL 60045 | ANTHEM BLUE CROSS LIFE AND HEALTH INS CO | $5K | — | $5K | 3059.77% |
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 | 1,440 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 1,452 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO | 1,403 | $7.2M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INS CO | 1,869 | $174 |
| Vision | VISION SERVICE PLAN | 1,276 | $116K |
| Life insurance | UNUM LIFE INSURANCE CO | 1,440 | $396K |
| Short-term disability | UNUM LIFE INSURANCE CO | 1,440 | $396K |
| Long-term disability | UNUM LIFE INSURANCE CO | 1,440 | $396K |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE CO | 1,440 | $412K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,869 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.