| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD, STE 100 SCHAUMBURG, IL 60173 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $20K | — | $20K | 2.45% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL | PO BOX 62689 VIRGINIA BEACH, VA 23466 | BLUE CROSS BLUE SHIELD OF ILLINOIS | — | $2K | $2K | 0.21% |
| HEALTH SPECIAL RISK, INC.3 Filed as: HEALTH SPECIAL RISK INC | 880 SIBLEY MEMORIAL HWY, STE 101 MENDOTA HEIGHTS, MN 55118 | ACE AMERICAN INSURANCE COMPANY | $3K | — | $3K | 8.00% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | CIGNA HEALTH AND LIFE INSURANCE CO | $3K | — | $3K | 9.89% |
| HEALTH SPECIAL RISK, INC.3 | 880 SIBLEY MEMORIAL HWY, STE 101 MENDOTA HEIGHTS, MN 55118 | BERKLEY LIFE AND HEALTH INS CO | $1K | $206 | $1K | 27.99% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 62689 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE CO OF NORTH AMERICA | $647 | $569 | $1K | 28.18% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD, STE 100 SCHAUMBURG, IL 60173 | HM LIFE INSURANCE CO | $363 | — | $363 | 10.01% |
| JOHN LESLIE PECK3 | 2727 ULMERTON RD, STE 230 CLEARWATER, FL 33762 | AMERICAN HERITAGE LIFE INS CO | $14 | — | $14 | 1.49% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | LIFE INSURANCE CO OF NORTH AMERICA | $136 | $52 | $188 | 20.66% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | LIFE INSURANCE CO OF NORTH AMERICA | $39 | $22 | $61 | 23.28% |
| JOHN LESLIE PECK3 | 2727 ULMERTON RD, STE 230 CLEARWATER, FL 33762 | AMERICAN HERITAGE LIFE INS CO | $3 | — | $3 | 2.88% |
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 | 171 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 177 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 324 | $823K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE CO | 178 | $35K |
| Vision | HM LIFE INSURANCE CO | 189 | $4K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE CO OF NORTH AMERICA | 167 | $1K |
| Long-term disability | LIFE INSURANCE CO OF NORTH AMERICA | 167 | $4K |
| Other(4 contracts, 4 carriers) | ACE AMERICAN INSURANCE COMPANY | 171 | $46K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 324 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.