| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY, LTD | 1750 EAST GOLF ROAD SCHAUMBURG, IL 60173 | BLUECROSS BLUESHIELD HEALTHCARE PLAN OF GEORGIA | $25K | — | $25K | 1.49% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 1750 E GOLF RD SCHAUMBURG, IL 60173 | DEARBORN NATIONAL LIFE INSURANCE CO | $25K | $8K | $33K | 25.29% |
| COMMERCIAL GRP INTERMEDIARIES, INC.3 Filed as: COMMERCIAL GRP INTERMEDIARIES, INC | 16 EXECUTIVE CT, STE 4 SOUTH BARRINGTON, IL 60010 | DEARBORN NATIONAL LIFE INSURANCE CO | — | $101 | $101 | 0.08% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY, LTD | 1750 EAST GOLF ROAD SCHAUMBURG, IL 60173 | DELTA DENTAL INSURANCE COMPANY | $13K | — | $13K | 10.00% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 1750 E GOLF RD SCHAUMBURG, IL 60173 | EYEMED VISION CARE | $2K | — | $2K | 9.12% |
| FLEXVISION - MD3 Filed as: FLEXVISION-MD | 15400 CALHOUN DR, STE 125 ROCKVILLE, MD 20855 | EYEMED VISION CARE | $1K | — | $1K | 4.56% |
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 | 155 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 14 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD HEALTHCARE PLAN OF GEORGIA | 267 | $1.7M |
| Dental | DELTA DENTAL INSURANCE COMPANY | 485 | $130K |
| Vision | EYEMED VISION CARE | 474 | $26K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE CO | 180 | $132K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE CO | 180 | $132K |
| Long-term disability | DEARBORN NATIONAL LIFE INSURANCE CO | 180 | $132K |
| Other | DEARBORN NATIONAL LIFE INSURANCE CO | 180 | $132K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 485 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.