| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 2 NORTH MARTINGALE ROAD SCHAUMBURG, IL 60173 | BLUECROSS BLUESHIELD OF ILLINOIS | $322K | — | $322K | 2.82% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 2 NORTH MARTINGALE ROAD SCHAUMBURG, IL 60173 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $67K | $6K | $73K | 21.46% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 2 NORTH MARTINGALE ROAD SCHAUMBURG, IL 60173 | UNUM LIFE INSURANCE COMPANY | $36K | $3K | $40K | 21.90% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 2 NORTH MARTINGALE ROAD SCHAUMBURG, IL 60173 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $11K | — | $11K | 10.41% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 2 NORTH MARTINGALE ROAD SCHAUMBURG, IL 60173 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 23.94% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF ILLINOIS EIN 36-1236610 CONTRCTADMTRTR | Contract Administrator; Direct payment from the plan Service code 13 | — | $1.0M |
| HEALTHIEST YOU NONE | Other services; Contract Administrator Service code 13 | 5350 EAST HIGH STREET SUITE 350 PHOENIX, AZ 85054 | $72K |
| RSM US LLP EIN 42-0714325 NONE | Accounting (including auditing) Service code 10 | — | $17K |
| WELLS FARGO NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 420 MONTGOMERY STREET SAN FRANCISCO, CA 94104 | $8K |
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 | 1,030 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 18 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 51 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,099 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 1,233 | $101K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,314 | $341K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,314 | $341K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,314 | $341K |
| Stop-loss / reinsurancereinsurance | BLUECROSS BLUESHIELD OF ILLINOIS | 1,544 | $11.4M |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,314 | $610K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,544 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.