| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RICHARD RUSCITTI Filed as: RICHARD T RUSCITTI | 1537 N CLYBOURN CHICAGO, IL 60610 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $100K | — | $100K | 3.16% |
| RICHARD RUSCITTI Filed as: RICHARD T RUSCITTI | 1537 CLYBOURN CHICAGO, IL 60610 | DELTA DENTAL OF ILLINOIS | $10K | — | $10K | 5.00% |
| RICK RUSCITTI Filed as: RICK T RUSCITTI | 1537 N CLYBOURN AVE CHICAGO, IL 60610 | DEARBORN NATIONAL LIFE | $15K | $167 | $15K | 12.89% |
| LAKE MICHIGAN BENEFIT ASSOC. Filed as: LAKE MICHIGAN BENEFIT ASSOC | 800 ROOSEVELT ROAD SUITE B108 GLEN ELLYN, IL 60137 | MONY LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 12.49% |
| LAKE MICHIGAN BENEFIT ASSOC. Filed as: LAKE MICHIGAN BENEFIT ASSOICATION | 800 ROSELVET ROAD SUITE 108 BLDG 8 GLEN ELLYN, IL 60137 | UNUM LIFE INSURANCE OF AMERICA | $5K | — | $5K | 15.07% |
| RICHARD RUSCITTI Filed as: RICHARD T RUSCITTI | 1537 N CLYBOURN AVE UNIT E CHICAGO, IL 60610 | VISION SERVICE PLAN | $13K | $0 | $13K | 49.55% |
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 | 483 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 483 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 513 | $3.2M |
| Dental | DELTA DENTAL OF ILLINOIS | 257 | $200K |
| Vision | VISION SERVICE PLAN | 180 | $26K |
| Life insurance(2 contracts, 2 carriers) | DEARBORN NATIONAL LIFE | 722 | $189K |
| Short-term disability(2 contracts, 2 carriers) | MONY LIFE INSURANCE COMPANY OF AMERICA | 722 | $108K |
| Long-term disability(2 contracts, 2 carriers) | MONY LIFE INSURANCE COMPANY OF AMERICA | 722 | $108K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ILLINOIS | 513 | $3.2M |
| Other | DEARBORN NATIONAL LIFE | 380 | $116K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 722 | — |
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.