| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUESTONE ADVISORS LLC Filed as: BLUESTONE ADVISORS | 1401 BRANDING LANE SUITE 350 DOWNERS GROVE, IL 60515 | BLUECROSS BLUESHIELD OF ILLINOIS | $0 | — | $0 | 0.00% |
| BLUESTONE ADVISORS LLC3 Filed as: BLUESTONE ADVISORS | 1401 BRANDING LANE SUITE 350 DOWNERS GROVE, IL 60515 | DEARBORN NATIONAL | $22K | — | $22K | 19.09% |
| GIS BENEFITS INC3 | 107 CANDLELIGHT LN MORRIS, IL 60450 | DEARBORN NATIONAL | $7K | — | $7K | 5.98% |
| BLUESTONE ADVISORS LLC3 Filed as: BLUESTONE ADVISORS, LLC | 1401 BRANDING LANE SUITE 350 DOWNERS GROVE, IL 60515 | VSP | $678 | — | $678 | — |
| BLUESTONE ADVISORS LLC3 Filed as: BLUESTONE ADVISORS | 1401 BRANDING LANE SUITE 350 DOWNERS GROVE, IL 60515 | DELTA DENTAL | $5K | — | $5K | — |
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 | 306 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Beneficiaries receiving benefits | 1 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 308 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 306 | $1.5M |
| Dental | DELTA DENTAL | 138 | $0 |
| Vision | VSP | 118 | $0 |
| Life insurance | DEARBORN NATIONAL | 251 | $117K |
| Short-term disability | DEARBORN NATIONAL | 251 | $117K |
| Long-term disability | DEARBORN NATIONAL | 251 | $117K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 306 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.