| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSOCIATED AGENCIES, INC3 Filed as: ASSOCIATED AGENCIES INC. | 1701 GOLF ROAD TOWER 3, SUITE 700 ROLLING MEADOWS, IL 60008 | EXCELLUS BLUE CROSS BLUE SHIELD | $3K | — | $3K | 0.97% |
| HOME OFFICE TPA PAYS COMMISSION | 475 FALLBROOK BLVD. LINCOLN, NE 68521 | AMERITAS | $9K | — | $9K | 5.01% |
| MARK S METTILLE Filed as: MARK S. METTILLE | 422 WAUPONSEE STREET MORRIS, IL 60450 | AMERITAS | — | $5K | $5K | 2.78% |
| ASSOCIATED AGENCIES, INC3 Filed as: ASSOCIATED AGENCIES INC. | 1701 GOLF ROAD TOWER 3, SUITE 700 ROLLING MEADOWS, IL 60008 | THE HARTFORD LIFE AND ACCIDENT | $3K | — | $3K | 4.20% |
| ASSOCIATED AGENCIES, INC3 Filed as: ASSOCIATED AGENCIES INC. | 1701 GOLF ROAD ROLLING MEADOWS, IL 60008 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $6K | $872 | $7K | 12.11% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $3K | $3K | 4.82% |
| BOON CHAPMAN BNFT ADMNSTRS INC3 Filed as: BOON CHAPMAN BNFT ADMNSTRS INC. | P.O. BOX 9201 AUSTIN, TX 78766 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $2K | $2K | 3.73% |
| ASSOCIATED AGENCIES, INC3 Filed as: ASSOCIATED AGENCIES INC. | 1701 GOLF ROAD TOWER 3, SUITE 700 ROLLING MEADOWS, IL 60008 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $6K | $787 | $6K | 13.96% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $2K | $2K | 5.13% |
| BOON CHAPMAN BNFT ADMNSTRS INC3 Filed as: BOON CHAPMAN BNFT ADMNSTRS INC. | P.O BOX 9201 AUSTIN, TX 78766 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $2K | $2K | 3.73% |
| ASSOCIATED AGENCIES, INC3 Filed as: ASSOCIATED AGENCIES INC. | 1701 GOLF ROAD TOWER 3 SUITE 700 ROLLING MEADOWS, IL 60008 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $7K | $1K | $8K | 18.08% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $3K | $3K | 7.33% |
| BOON CHAPMAN BNFT ADMNSTRS INC3 Filed as: BOON CHAPMAN BNFT ADMNSTRS INC. | P.O. BOX 9201 AUSTIN, TX 78766 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $2K | $2K | 3.73% |
| ASSOCIATED AGENCIES, INC3 Filed as: ASSOCIATED AGENCIES INC. | 1701 GOLF ROAD TOWER 3, SUITE 700 ROLLING MEADOWS, IL 60008 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $1K | $104 | $1K | 16.64% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $506 | $506 | 7.33% |
| BOON CHAPMAN BNFT ADMNSTRS INC3 Filed as: BOON CHAPMAN BNFT ADMNSTRS INC. | P.O. BOX 9201 AUSTIN, TX 78766 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $352 | $352 | 5.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUE CROSS BLUE SHIELD EIN 15-0329043 NONE | Claims processing Service code 12 | 165 COURT STREET ROCHESTER, NY 14647 | $166K |
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 | 186 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 186 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS | 435 | $174K |
| Vision | AMERITAS | 435 | $174K |
| Life insurance | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 634 | $59K |
| Stop-loss / reinsurancereinsurance | EXCELLUS BLUE CROSS BLUE SHIELD | 186 | $354K |
| Other(5 contracts, 2 carriers) | THE HARTFORD LIFE AND ACCIDENT | 634 | $240K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 634 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.