| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 | 1750 EAST GOLF ROAD ONE CENTURY CENTRE SCHAUMBURG, IL 60173 | BLUECROSS BLUESHIELD OF ILLINOIS | $68K | $2K | $69K | 4.03% |
| FABRIK MOLDED PLASTICS3 | 5213 PRIME PARKWAY MCHENRY, IL 60050 | BLUECROSS BLUESHIELD OF ILLINOIS | — | $1 | $1 | 0.00% |
| ASSURANCE AGENCY LTD3 | 1750 EAST GOLF ROAD ONE CENTURY CENTRE SCHAUMBURG, IL 60173 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $17K | $3K | $21K | 16.17% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 1750 EAST GOLF ROAD SCHAUMBURG, IL 60173 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 10.13% |
| ASSURANCE AGENCY LTD3 | 1750 EAST GOLF ROAD 11 FLOOR SCHAUMBURG, IL 60173 | PRE-PAID LEGAL SERVICES DBA LEGALSHIELD | $184 | — | $184 | 15.38% |
| SMART SHIELD INC.3 Filed as: SMART SHIELD INC | 332 KINGSPORT COURT CRYSTAL LAKE, IL 60012 | PRE-PAID LEGAL SERVICES DBA LEGALSHIELD | $66 | — | $66 | 5.52% |
| ABBE G HEIDORN3 | 2725 BLUE GRASS COURT GRAYSLAKE, IL 60030 | PRE-PAID LEGAL SERVICES DBA LEGALSHIELD | $14 | — | $14 | 1.17% |
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 | 280 | 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. |
| Total participants (= "Plan participants" tile) | 280 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 277 | $1.7M |
| Dental | BLUECROSS BLUESHIELD OF ILLINOIS | 277 | $1.7M |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 189 | $12K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 280 | $128K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 280 | $128K |
| Long-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 280 | $128K |
| Other(2 contracts, 2 carriers) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 280 | $129K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 280 | — |
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.