| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EVERGREEN BENEFITS GROUP3 | 7040 N RIDGEWAY AVE LINCOLNWOOD, IL 60712 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $39K | $3K | $42K | 13.26% |
| LEVINE & REID INC.3 Filed as: LEVINE & REID INC | 8700 W BRYAN MAWR AVE SUITE 740 CHICAGO, IL 60631 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $241 | $0 | $241 | 0.08% |
| EVERGREEN BENEFITS GROUP3 Filed as: EVERGREEN BENEFITS GROUP LLC | 7040 N RIDGEWAY AVE LINCOLNWOOD, IL 60712 | COMBINED INSURANCE COMPANY OF AMERICA | $36K | $0 | $36K | 28.11% |
| JOSHUA NUDELL3 | 2832 W GREENLEAF AVE CHICAGO, IL 60645 | COMBINED INSURANCE COMPANY OF AMERICA | $36K | $0 | $36K | 28.08% |
| BENEFITS ALL INSURANCE, LLC3 Filed as: BENEFITS ALL INSURANCE LLC | 8040 HOSBROOK RD SUITE 100 CINCINNATI, OH 45236 | COMBINED INSURANCE COMPANY OF AMERICA | $12K | $0 | $12K | 9.02% |
| EVERGREEN BENEFITS GROUP3 | 7040 N RIDGEWAY AVE LINCOLNWOOD, IL 60712 | COMBINED INSURANCE COMPANY | $43K | $0 | $43K | 45.00% |
| JOSHUA NUDELL3 | — | COMBINED INSURANCE COMPANY | $43K | $0 | $43K | 45.00% |
| BENEFITS ALL IN LLC3 Filed as: BENEFITS ALL IN | 8040 HOSBROOK RD SUITE 100 CINCINNATI, OH 45236 | COMBINED INSURANCE COMPANY | $9K | $0 | $9K | 9.00% |
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 | 420 | 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) | 420 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 475 | $317K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 475 | $317K |
| Life insurance | COMBINED INSURANCE COMPANY | 133 | $95K |
| Short-term disability | COMBINED INSURANCE COMPANY OF AMERICA | 723 | $130K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 475 | $317K |
| Other(2 contracts, 2 carriers) | COMBINED INSURANCE COMPANY OF AMERICA | 723 | $225K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 723 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.