| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | BLUECROSS BLUESHIELD OF ILLINOIS | $37K | $6 | $37K | 3.59% |
| HOLSTEN MANAGEMENT3 | 1020 WEST MONTROSE AVENUE CHICAGO, IL 60613 | BLUECROSS BLUESHIELD OF ILLINOIS | $0 | $3 | $3 | 0.00% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY INC | 225 KENNETH DRIVE ROCHESTER, NY 14623 | PRINCIPAL LIFE INSURANCE COMPANY | $11K | $0 | $11K | 8.59% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | PRINCIPAL LIFE INSURANCE COMPANY | -$1 | $680 | $679 | 0.55% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY | PO BOX 948 HENRIETTA, NY 14467 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $770 | $0 | $770 | 10.04% |
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 | 113 | 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) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 109 | $1.0M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 138 | $124K |
| Vision | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | 128 | $8K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 138 | $124K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 138 | $124K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 138 | $124K |
| Prescription drug | BLUECROSS BLUESHIELD OF ILLINOIS | 109 | $1.0M |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 138 | $124K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 138 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.