| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 | — | BLUECROSS BLUESHIELD OF ILLINOIS | $92K | $2K | $94K | 5.09% |
| ASSURANCE AGENCY LTD3 | 1750 EAST GOLF ROAD SUITE 1100 SCHAUMBURG, IL 60173 | AMERITAS LIFE INSURANCE CORP. | $15K | $156 | $15K | 10.10% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY LTD. | 1750 EAST GOLF ROAD SUITE 1100 SCHAUMBURG, IL 60173 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $12K | $2K | $14K | 15.06% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY, LTD. | 1750 EAST GOLF ROAD SUITE 140 SCHAUMBURG, IL 60173 | VISION SEREVICE PLAN | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLIED BENEFIT SYSTEMS INC. EIN 36-3086057 TPA | Contract Administrator Service code 13 | — | $154K |
| ASSURANCE AGENCY EIN 36-2656887 BROKER | Insurance agents and brokers Service code 22 | — | $136K |
| MULTIPLAN EIN 04-3138814 SERVICE PROVIDER | Insurance services Service code 23 | — | $30K |
| TELADOC EIN 35-2351217 SERVICE PROVIDER | Insurance services Service code 23 | — | $14K |
| CIGNA EIN 59-1031071 SERVICE PROVIDER | Insurance services Service code 23 | — | $13K |
| PHCS EIN 04-3138814 SERVICE PROVIDER | Insurance services Service code 23 | — | $2K |
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 | 903 | 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) | 903 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 290 | $1.8M |
| Dental | AMERITAS LIFE INSURANCE CORP. | 256 | $150K |
| Vision | VISION SEREVICE PLAN | 235 | $25K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 293 | $92K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 293 | $92K |
| Long-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 293 | $92K |
| Stop-loss / reinsurancereinsurance(4 contracts, 2 carriers) | QBE INSURANCE CORPORATION | 713 | $242K |
| Other(3 contracts, 2 carriers) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 713 | $151K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 713 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.