| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIAM FERGUSON3 Filed as: WILLIAM BUCHANAN, SR | 2305 EAST PARIS SE, STE 201 GRAND RAPIDS, MI 49546 | GREEN VALLEY HEALTH PLAN | $6K | — | $6K | 2.27% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY, LTD | 1750 E GOLF RD, STE 1100 SCHAUMBURG, IL 60173 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | $493 | $12K | 4.56% |
| SIDNEY COPLESTON3 | 133 RIVER LANDING DR CHARLESTON, IL 61920 | METROPOLITAN LIFE INSURANCE COMPANY | — | $11K | $11K | 4.32% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY, LTD | 1750 E GOLF RD SCHAUMBURG, IL 60173 | UNITED HEALTHCARE INSURANCE COMPANY | $8K | $3K | $11K | 5.64% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INS AGENCY | 150 SAWGRASS DR ROCHESTER, NY 14620 | UNITED HEALTHCARE INSURANCE COMPANY | — | $86 | $86 | 0.04% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 1750 E GOLF RD SCHAUMBURG, IL 60173 | AMERITAS | $7K | — | $7K | 9.76% |
| FRINGE INSURANCE BENEFITS, INC.3 Filed as: FRINGE INSURANCE BENEFITS | 11910 ANDERSON MILL ROAD AUSTIN, TX 78726 | AMERITAS | $4K | — | $4K | 5.37% |
| FRINGE INSURANCE BENEFITS, INC.3 Filed as: FRINGE INSURANCE BENEFITS, INC | 11910 ANDERSON MILL RD AUSTIN, TX 78726 | NATIONWIDE LIFE INSURANCE | $6K | — | $6K | 9.96% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 1750 E GOLF RD SCHAUMBURG, IL 60173 | NATIONWIDE LIFE INSURANCE | $6K | — | $6K | 9.85% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 1750 E GOLF RD SCHAUMBURG, IL 60173 | EYEMED VISION CARE | $3K | — | $3K | 8.83% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 1750 E GOLF RD SCHAUMBURG, IL 60173 | UNION SECURITY INSURANCE CO | $2K | $36 | $2K | 14.39% |
| BUCHANAN AGENCY INC.3 Filed as: BUCHANAN INS SERVICES AGENCY | 2305 E PARIS SE, STE 201 GRAND RAPIDS, MI 49546 | UNUM LIFE INSURANCE CO OF AMERICA | $1K | — | $1K | 10.00% |
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 | 374 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 374 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | GREEN VALLEY HEALTH PLAN | 234 | $682K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 726 | $325K |
| Vision(2 contracts, 2 carriers) | AMERITAS | 547 | $99K |
| Life insurance(4 contracts, 4 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 726 | $345K |
| Short-term disability(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 726 | $329K |
| Long-term disability(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 726 | $330K |
| Prescription drug | GREEN VALLEY HEALTH PLAN | 168 | $261K |
| Other(4 contracts, 4 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 726 | $345K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 726 | — |
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.