| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EXECUTIVE FIDELITY3 | P.O. BOX 72668 ROSELLE, IL 601720668 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | $0 | $1K | 0.98% |
| COMMERICAL GROUP INTERMEDIARIES3 Filed as: COMMERICAL GROUP INTERMEDIARIES INC | 16 EXECUTIVE CT STE 4 BARRINGTON, IL 600109528 | METROPOLITAN LIFE INSURANCE COMPANY | $443 | $0 | $443 | 0.29% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF ILLINOIS EIN 36-1236610 NONE | Other insurance fees and expenses; Claims processing; Contract Administrator Service code 12 | — | $71K |
| ARNOLD & KADJAN EIN 36-2498571 NONE | Legal Service code 29 | — | $28K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Accounting (including auditing) Service code 10 | — | $28K |
| TFBC, LLC EIN 27-3782504 NONE | Actuarial; Consulting (general) Service code 11 | — | $17K |
| SAVRX EIN 47-0527013 NONE | Claims processing Service code 12 | — | $11K |
| INNOVATIVE SOFTWARE SOLUTIONS EIN 23-2182079 NONE | Other services; Consulting (general) Service code 16 | — | $6K |
| MARCO CONSULTING GROUP, INC. EIN 36-3555078 NONE | Investment advisory (plan) Service code 27 | — | $5K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 463 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 463 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 532 | $150K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 532 | $150K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 532 | — |
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.