| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| S J BENEFITS GROUP INC3 | 2200 SOUTH MAIN ST STE 100 LOMBARD, IL 60148 | BLUECROSS BLUESHILD OF ILLINOIS | $48K | — | $48K | 3.91% |
| S J BENEFITS GROUP INC3 | 2200 SOUTH MAIN ST STE 100 LOMBARD, IL 60148 | AMERITAS LIFE INSURANCE CORP | $3K | — | $3K | 3.40% |
| S J BENEFITS GROUP INC | 2200 SOUTH MAIN ST STE 100 LOMBARD, IL 60148 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| S J BENEFITS GROUP INC | 2200 SOUTH MAIN ST STE 100 LOMBARD, IL 60148 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 15.00% |
| DAVID J MCCLELLAN3 Filed as: DAVID E WYATT | 1011 N 49TH AVE OMAHA, NE 68132 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $40 | — | $40 | 3.80% |
| DIANE G. DAVIDSON3 Filed as: DIANE G DAVIDSON | 72 HIGH STREET BUTLER, NJ 07405 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $8 | — | $8 | 0.76% |
| FRANK M DARTEE3 | 12 MOONSHADOW CT KINNELON, NY 07405 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $7 | — | $7 | 0.66% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT E ELLIS | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $6 | — | $6 | 0.57% |
| RK HUGHES INC3 | 185 KINGSLAND ST PO BOX 67 NUTLEY, NJ 07110 | CIGNA GROUP INSURANCE | $12 | — | $12 | 15.58% |
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 | 270 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 270 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHILD OF ILLINOIS | 270 | $1.2M |
| Dental | AMERITAS LIFE INSURANCE CORP | 107 | $91K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 146 | $18K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 146 | $27K |
| Other(3 contracts, 3 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 146 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 270 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.