| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $65K | $3K | $68K | 4.08% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | METROPOLITAN LIFE INSURANCE CO | $2K | $849 | $3K | 3.16% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | UNITED OF OMAHA LIFE INS CO | $7K | $461 | $7K | 14.51% |
| UNITED OF OMAHA LIFE INSURANCE CO5 Filed as: UNITED OF OMAHA | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INS CO | — | $5K | $5K | 9.65% |
| FMLASOURCE INC3 | 455 N CITYFRONT PLZ DR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INS CO | — | $3K | $3K | 5.56% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | EYEMED | $949 | — | $949 | 5.38% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | EYEMED | $19 | — | $19 | 8.64% |
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 | 134 | 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) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 275 | $1.7M |
| Dental | METROPOLITAN LIFE INSURANCE CO | 404 | $98K |
| Vision(2 contracts) | EYEMED | 284 | $18K |
| Life insurance | UNITED OF OMAHA LIFE INS CO | 137 | $49K |
| Long-term disability | UNITED OF OMAHA LIFE INS CO | 137 | $49K |
| Other | UNITED OF OMAHA LIFE INS CO | 137 | $49K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 404 | — |
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.