| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VISTA NATIONAL INSURANCE GROUP INC3 | — | BLUECROSS BLUESHIELD OF ILLINOIS | $33K | $873 | $34K | 1.77% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES, I | — | BLUECROSS BLUESHIELD OF ILLINOIS | $19K | — | $19K | 0.98% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF ILLINOIS INC | — | BLUECROSS BLUESHIELD OF ILLINOIS | $18K | — | $18K | 0.94% |
| KOMAX CORPORATION3 | 1100 CORPORATE GROVE DRIVE BUFFALO GROVE, IL 60089 | BLUECROSS BLUESHIELD OF ILLINOIS | — | $1 | $1 | 0.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF ILLINOIS INC | 263 SHUMAN BOULEVARD SUITE 110 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 4.05% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SVCS INC | 263 SHUMAN BOULEVARD SUITE 110 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $98 | — | $98 | 0.14% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF ILLINOIS INC | 263 SHUMAN BOULEVARD SUITE 110 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 7.65% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SVCS INC | 263 SHUMAN BOULEVARD SUITE 110 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $203 | — | $203 | 0.42% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF ILLINOIS INC | 263 SHUMAN BOULEVARD SUITE 110 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 9.16% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SVCS INC | 263 SHUMAN BOULEVARD SUITE 110 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $210 | — | $210 | 0.84% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF ILLINOIS INC | 263 SHUMAN BOULEVARD SUITE 110 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 12.40% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SVCS INC | 263 SHUMAN BOULEVARD SUITE 110 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $194 | — | $194 | 0.84% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF ILLINOIS INC | 263 SHUMAN BOULEVARD SUITE 110 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 13.78% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SVCS INC | 263 SHUMAN BOULEVARD SUITE 110 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $266 | — | $266 | 1.22% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES, I | 1301 WEST 22ND STREET SUITE 600 OAK BROOK, IL 60523 | VISION SERVICE PLAN | $707 | — | $707 | 5.09% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF ILLINOIS, INC | 1301 WEST 22ND STREET SUITE 600 OAK BROOK, IL 60523 | VISION SERVICE PLAN | $257 | — | $257 | 1.85% |
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 | 104 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 220 | $1.9M |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 90 | $69K |
| Vision | VISION SERVICE PLAN | 76 | $14K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 104 | $71K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 104 | $25K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 104 | $23K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 104 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 220 | — |
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.