Form 5500 · Employee benefit plan · LAKE FOREST, IL
LAKE FOREST ACADEMY
The filing calls this plan LAKE FOREST ACADEMY HEALTH & WELFARE BENEFIT PLAN.
Public Form 5500 records show how LAKE FOREST ACADEMY of LAKE FOREST, IL, a education employer, structures its employee benefits. Its broker of record is TIC INC.. Coverage is written through BLUECROSS BLUESHIELD OF ILLINOIS and 2 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 36-2216167 · plan 501 · plan year 2025, filed Jan 8, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: death benefits, other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 3 insured contracts covering health, vision, life and disability; the largest, with BLUECROSS BLUESHIELD OF ILLINOIS, covers 267 people.
The filing declares health, vision, life, disability and dental. Dental appears with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
Reported premium across the insured contracts is $2,502,661, with $104,894 in disclosed broker commissions — about 4.2% of premium.
The most recent policy period ended in June, and the plan year ends June 30. Group contracts typically renew on that annual cycle.
TIC INC. is the broker of record on all 3 contracts.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUECROSS BLUESHIELD OF ILLINOIS | Health | 267 | Jul 1, 2025 | $2,409,495 | $92,292 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life, Disability | 151 | Jul 1, 2025 | $76,444 | $11,466 |
| VISION SERVICE PLAN | Vision | 105 | Jul 1, 2025 | $16,722 | $1,136 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Other plans filed by this employer
How this plan compares
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