| 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 | $2K | -$18K | -1.02% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | CIGNA HEALTH AND LIFE INSURANCE CO | $13K | $2K | $14K | 11.13% |
| 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 | $10K | — | $10K | 8.00% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGNCY | 20 N MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | LIFE INSURANCE CO OF NORTH AMERICA | $4K | $351 | $5K | 16.20% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD, STE 100 SCHAUMBURG, IL 60173 | HM LIFE INSURANCE CO | $1K | — | $1K | 8.40% |
| MARSH & MCLENNAN AGENCY LLC3 | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | HM LIFE INSURANCE CO | $245 | — | $245 | 1.60% |
| HEALTH SPECIAL RISK, INC.3 | 880 SIBLEY MEMORIAL HWY, STE 101 MENDOTA HEIGHTS, MN 55118 | BERKLEY LIFE AND HEALTH INS CO | $1K | — | $1K | 28.01% |
| JOHN LESLIE PECK3 | 2727 ULMERTON RD, STE 230 CLEARWATER, FL 33762 | AMERICAN HERITAGE LIFE INS CO | $62 | — | $62 | 1.35% |
| JENNON M CARUTH3 | 7825 WASHINGTON AVE S, STE 710 MINNEAPOLIS, MN 55439 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 53.31% |
| ASSURANCE AGENCY LTD3 | 20 N MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | HARTFORD LIFE AND ACCIDENT | $779 | — | $779 | 22.84% |
| WEBTPA EMPLOYER SERVICES LLC3 | 8500 FREEPORT PKWY SOUTH IRVING, TX 75063 | HARTFORD LIFE AND ACCIDENT | — | $204 | $204 | 5.98% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | LIFE INSURANCE CO OF NORTH AMERICA | $383 | $35 | $418 | 16.38% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | LIFE INSURANCE CO OF NORTH AMERICA | $173 | — | $173 | 15.00% |
| JOHN LESLIE PECK3 | 2727 ULMERTON RD, STE 230 CLEARWATER, FL 33762 | AMERICAN HERITAGE LIFE INS CO | $10 | — | $10 | 2.40% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | LIFE INS CO OF NORTH AMERICA | $23 | $466 | $489 | 211.69% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | LIFE INSURANCE CO OF NORTH AMERICA | $4 | $47 | $51 | 134.21% |
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 | 146 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 310 | $1.8M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE CO | 176 | $128K |
| Vision | HM LIFE INSURANCE CO | 172 | $15K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE CO OF NORTH AMERICA | 146 | $3K |
| Long-term disability | LIFE INSURANCE CO OF NORTH AMERICA | 147 | $29K |
| Other(7 contracts, 6 carriers) | ACE AMERICAN INSURANCE COMPANY | 325 | $135K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 325 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.