| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| M3 INSURANCE SOLUTIONS INC3 Filed as: AUTOMATIC DATA PROCESSSING INSURANC | — | BLUE CROSS AND BLUE SHIELD OF ILLINOIS | $99K | $1K | $100K | 3.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | — | BLUE CROSS AND BLUE SHIELD OF ILLINOIS | $23K | — | $23K | 0.75% |
| ADP INC3 Filed as: AUTOMATIC DATA PROCESSING INSURANCE | 1 ADP BOULEVARD MS 625 ROSELAND, NJ 07068 | BLUE CROSS AND BLUE SHIELD OF ILLINOIS | — | $12 | $12 | 0.00% |
| OLD MISSION CAPITAL, LLC3 | 1 NORTH DEARBORN STREET 8TH FLOOR CHICAGO, IL 60602 | BLUE CROSS AND BLUE SHIELD OF ILLINOIS | — | $6 | $6 | 0.00% |
| ADP INC3 Filed as: AUTOMATIC DATA PROCESSING | 71 HANOVER ROAD FLORHAM PARK, NJ 07932 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | $4K | $13K | 10.77% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PARK CENTRAL 7/12750 MERIT DRIVE SUITE 1000 DALLAS, TX 75251 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 2.23% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | DEARBORN LIFE INSURANCE COMPANY | $711 | — | $711 | 3.06% |
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 | 216 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 216 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF ILLINOIS | 451 | $3.0M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF ILLINOIS | 451 | $3.1M |
| Vision(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 225 | $142K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 222 | $118K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 222 | $118K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 222 | $118K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 222 | $118K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 451 | — |
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.