| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAUL KELLY3 | 56 GENTRY DRIVE HAWTHORN WOODS, IL 60047 | BLUE CROSS BLUE SHIELD OF ARIZONA | $29K | — | $29K | 4.88% |
| FRED S NOVY3 Filed as: FRED NOVY | 1751 LAKE COOK ROAD SUITE 200 DEERFIELD, IL 60015 | AETNA LIFE INSURANCE COMPANY | $5K | — | $5K | 3.45% |
| PAUL KELLY3 | 56 GENTRY DRIVE HAWTHORN WOODS, IL 60047 | AETNA LIFE INSURANCE COMPANY | $5K | — | $5K | 3.45% |
| FRED S NOVY3 | 1751 LAKE COOK ROAD SUITE 200 DEERFIELD, IL 60015 | THE PAUL REVERE INSURANCE COMPANH | $5K | — | $5K | 6.86% |
| PAUL KELLY3 | 56 GENTRY DRIVE HAWTHORN WOODS, IL 60047 | THE PAUL REVERE INSURANCE COMPANH | $5K | — | $5K | 6.86% |
| FRED S NOVY3 | 1751 LAKE COOK ROAD SUITE 200 DEERFIELD, IL 60015 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $24K | — | $24K | — |
| PAUL KELLY3 | 56 GENTRY DRIVE HAWTHORN WOODS, IL 60047 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $24K | — | $24K | — |
| PAUL KELLY3 | 56 GENTRY DRIVE HAWTHORN WOODS, IL 60047 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | — |
| FRED S NOVY3 | 1751 LAKE COOK ROAD SUITE 200 DEERFIELD, IL 60015 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | — |
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 | 172 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 21 | Continuation coverage (COBRA, retiree health). |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 193 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF ARIZONA | 160 | $660K |
| Dental | AETNA LIFE INSURANCE COMPANY | 287 | $132K |
| Vision | BLUE CROSS BLUE SHIELD OF ARIZONA | 66 | $586K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 159 | $0 |
| Long-term disability | THE PAUL REVERE INSURANCE COMPANH | 160 | $74K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 287 | — |
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.