| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARC JACOBSON3 Filed as: MARC JACOBSON & ASSOCIATES | 425 HUEHL ROAD, STE 16B NORTHBROOK, IL 60062 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $0 | $3K | $3K | 0.72% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $9K | $2K | $10K | 4.31% |
| BOONE-CHAPMAN BENEFIT ADMINISTRATOR5 Filed as: BOONE CHAPMAN BENEFIT ADMINISTRATOR | 9401 AMBERGLEN BLVD, STE 100 AUSTIN, TX 78729 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $1K | $5K | 2.00% |
| MARC JACOBSON3 Filed as: MARC JACOBSON & ASSOCIATES | 425 HUEHL ROAD, STE 16B NORTHBROOK, IL 60062 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $4K | $4K | 1.58% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE ST MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $2K | $5K | 5.21% |
| MARC JACOBSON3 Filed as: MARC JACOBSON & ASSOCIATES | 425 HUEHL ROAD, STE 16B NORTHBROOK, IL 60062 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $2K | $2K | 2.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE ST MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE | $2K | $1K | $4K | 5.22% |
| MARC JACOBSON3 Filed as: MARC JACOBSON & ASSOCIATES | 425 HUEHL ROAD, STE 16B NORTHBROOK, IL 60062 | METROPOLITAN LIFE INSURANCE | $0 | $1K | $1K | 1.90% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $501 | $2K | 5.26% |
| MARC JACOBSON3 Filed as: MARC JACOBSON & ASSOCIATES | 425 HUEHI ROAD, STE 16B NORTHBROOK, IL 60062 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $399 | $399 | 0.96% |
| MARC JACOBSON3 Filed as: MARC JACOBSON & ASSOCIATES | 425 HUEHL ROAD, STE 16B NORTHBROOK, IL 60062 | GUARDIAN LIFE INSURANCE COMPANY | $2K | — | $2K | 9.92% |
| MARK J MATSOCK & ASSOCIATES INC3 Filed as: MARK S METTILE | 107 CANDLELITE LANE MORRIS, IL 60450 | GUARDIAN LIFE INSURANCE COMPANY | $257 | — | $257 | 1.44% |
| THE HUNKEN AGENCY, INC.3 Filed as: THE HUNKEN AGENCY INC | 2550 COMPASS ROAD GLENWOOD, IL 60026 | GUARDIAN LIFE INSURANCE COMPANY | $10 | — | $10 | 0.06% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $543 | $254 | $797 | 5.23% |
| MARC JACOBSON3 Filed as: MARC JACOBSON & ASSOCIATES | 425 HUEHL ROAD, STE 16B NORTHBROOK, IL 60062 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $276 | $276 | 1.81% |
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 | 795 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 795 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 795 | $415K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 795 | $256K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 795 | $42K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 795 | $90K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 795 | $15K |
| Long-term disability | METROPOLITAN LIFE INSURANCE | 795 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 795 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.