| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAUL KELLY3 | 56 GENTRY DRIVE HAWTHORN WOODS, IL 60047 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $30K | — | $30K | 1.96% |
| FRED S NOVY3 | 1751 LAKE COOK ROAD SUITE 200 DEERFIELD, IL 60015 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $30K | — | $30K | 1.96% |
| PAUL KELLY3 | 56 GENTRY DRIVE HAWTHORN WOODS, IL 60047 | BLUE CROSS BLUE SHIELD OF ARIZONA | $29K | — | $29K | 5.09% |
| PAUL KELLY3 | 56 GENTRY DRIVE HAWTHORN WOODS, IL 60047 | AETNA LIFE INSURANCE COMPANY | $7K | — | $7K | 4.99% |
| FRED S NOVY3 Filed as: FRED NOVY | 1751 LAKE COOK ROAD SUITE 200 DEERFIELD, IL 60015 | AETNA LIFE INSURANCE COMPANY | $7K | — | $7K | 4.99% |
| FRED S NOVY3 | 1751 LAKE COOK ROAD SUITE 200 DEERFIELD, IL 60015 | THE PAUL REVERE INSURANCE COMPANY | $6K | — | $6K | 7.50% |
| PAUL KELLY3 | 56 GENTRY DRIVE HAWTHORN WOODS, IL 60047 | THE PAUL REVERE INSURANCE COMPANY | $6K | — | $6K | 7.50% |
| PAUL KELLY3 | 56 GENTRY DRIVE HAWTHORN WOODS, IL 60047 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 9.23% |
| FRED S NOVY3 | 1751 LAKE COOK ROAD SUITE 200 DEERFIELD, IL 60015 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 9.23% |
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 | 150 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 30 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 180 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 160 | $2.2M |
| Dental | AETNA LIFE INSURANCE COMPANY | 302 | $146K |
| Vision | BLUE CROSS BLUE SHIELD OF ARIZONA | 105 | $577K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 148 | $68K |
| Long-term disability | THE PAUL REVERE INSURANCE COMPANY | 127 | $78K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 302 | — |
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.