| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY LTD. | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | BLUECROSS BLUESHIELD OF ILLINOIS | — | $16K | $16K | 0.65% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY LTD. | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | AETNA LIFE INSURANCE CO. | — | $7K | $7K | 3.72% |
| FMLASOURCE INC5 Filed as: FMLASOURCE INC. | 455 N. CITYFRONT PLZ DR. 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 6.65% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY LTD. | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 5.34% |
| MARSH & MCLENNAN AGENCY LLC3 | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 1.66% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY LTD. | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 11.61% |
| MARSH & MCLENNAN AGENCY LLC3 | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 3.40% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY LTD. | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | EYEMED VISION CARE | $3K | — | $3K | 11.92% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY LTD. | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $986 | — | $986 | 5.35% |
| MARSH & MCLENNAN AGENCY LLC3 | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $305 | — | $305 | 1.65% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY LTD. | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 7.66% |
| MARSH & MCLENNAN AGENCY LLC3 | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $396 | — | $396 | 2.34% |
| DIANE B KING3 | 621 WARWICK RD. KENILWORTH, IL 60043 | MANHATTANLIFE | $282 | — | $282 | 1.83% |
| MARSH & MCLENNAN AGENCY LLC4 | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $533 | — | $533 | 11.42% |
| LINDA COLLEEN LAMB4 | 2206 W. GRANVILLE AVE APT 1 CHICAGO, IL 60659 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $458 | — | $458 | 9.81% |
| MARY TURLEY4 | 34251 N. HOMESTEAD RD. GURNEE, IL 60031 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $147 | — | $147 | 3.15% |
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 | 352 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 355 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 611 | $2.5M |
| Dental | AETNA LIFE INSURANCE CO. | 659 | $190K |
| Vision | EYEMED VISION CARE | 556 | $27K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 352 | $32K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 348 | $65K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 349 | $18K |
| Other(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 352 | $76K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 659 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.