| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 1750 E GOLF RD SCHAUMBURG, IL 60173 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $33K | — | $33K | 2.73% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE | 700 WEST 47TH ST., STE 1100 KANSAS CITY, MO 64112 | BLUE CROSS BLUE SHIELD OF ILLINOIS | — | $1K | $1K | 0.11% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 1750 E GOLF RD SCHAUMBURG, IL 60173 | UNUM LIFE INSURANCE CO | $4K | $344 | $4K | 15.10% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE | 700 W 47TH ST., STE 1100 KANSAS CITY, MO 64112 | UNUM LIFE INSURANCE CO | $315 | $42 | $357 | 1.29% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 1750 E GOLF RD SCHAUMBURG, IL 60173 | UNUM LIFE INSURANCE CO | $3K | $237 | $3K | 14.26% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERV | 700 W 47TH ST., STE 1100 KANSAS CITY, KS 64112 | UNUM LIFE INSURANCE CO | — | $439 | $439 | 2.16% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 1750 E GOLF RD SCHAUMBURG, IL 60173 | UNUM LIFE INSURANCE CO | $703 | $94 | $797 | 10.93% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE | 700 W 47TH ST., STE 1100 KANSAS CITY, MO 64112 | UNUM LIFE INSURANCE CO | — | $31 | $31 | 0.43% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 1750 E GOLF RD SCHAUMBURG, IL 60173 | VISION SERVICE PLAN | $546 | — | $546 | 7.53% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE | PO BOX 632886 CINCINNATI, OH 45263 | VISION SERVICE PLAN | $61 | — | $61 | 0.84% |
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 | 96 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 101 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 225 | $1.2M |
| Dental | DELTA DENTAL OF ILLINOIS | 89 | $89K |
| Vision | VISION SERVICE PLAN | 62 | $7K |
| Life insurance | UNUM LIFE INSURANCE CO | 128 | $28K |
| Short-term disability | UNUM LIFE INSURANCE CO | 14 | $7K |
| Long-term disability | UNUM LIFE INSURANCE CO | 128 | $28K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ILLINOIS | 225 | $1.2M |
| Other(2 contracts) | UNUM LIFE INSURANCE CO | 128 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 225 | — |
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.