| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEMENS & ASSOCIATES LIFE AGENCY3 | 2806 EAST EMPIRE PO BOX 217 BLOOMINGTON, IL 61702 | BLUECROSS BLUESHIELD OF ILLINOIS | $85K | $2K | $86K | 2.30% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INSURANCE SRVCS | 800 MAIN ST DUBUQUE, IA 52001 | BLUECROSS BLUESHIELD OF ILLINOIS | $59K | — | $59K | 1.57% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INSURANCE | 800 MAIN ST DUBUQUE, IA 52001 | DELTA DENTAL OF ILLINOIS | $6K | — | $6K | 4.11% |
| CLEMENS & ASSOCIATES LIFE AGENCY3 | PO BOX 217 BLOOMINGTON, IL 617020217 | DELTA DENTAL OF ILLINOIS | $6K | — | $6K | 4.07% |
| CLEMENS & ASSOCIATES LIFE AGENCY3 Filed as: CLEMENS & ASSOC LIFE AGCY | PO BOX 217 BLOOMINGTON, IL 617020217 | STANDARD INSURANCE COMPANY | $6K | — | $6K | 4.22% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SRVCS | 800 MAIN ST DUBUQUE, IA 52001 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 1.71% |
| MARSH & MCLENNAN AGENCY LLC3 | 2500 CITY WEST BLVD STE 2400 HOUSTON, TX 77042 | STANDARD INSURANCE COMPANY | $24 | — | $24 | 0.02% |
| CLEMENS & ASSOCIATES LIFE AGENCY3 | PO BOX 217 BLOOMINGTON, IL 617020217 | VISION SERVICE PLAN | $806 | — | $806 | 4.07% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER, INC | PO BOX 28 DUBUQUE, IA 520040028 | VISION SERVICE PLAN | $661 | — | $661 | 3.34% |
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 | 230 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 231 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 394 | $3.8M |
| Dental | DELTA DENTAL OF ILLINOIS | 202 | $152K |
| Vision | VISION SERVICE PLAN | 203 | $20K |
| Life insurance | STANDARD INSURANCE COMPANY | 236 | $136K |
| Short-term disability | STANDARD INSURANCE COMPANY | 236 | $136K |
| Long-term disability | STANDARD INSURANCE COMPANY | 236 | $136K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 394 | — |
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.