| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WINE SERGI & CO LLC3 Filed as: WINE SERGI & COMPANY LLC | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | BLUECROSS BLUESHIELD OF ILLINOIS | $43K | $837 | $44K | 3.90% |
| WINE SERGI & CO LLC3 Filed as: WINE SERGI & COMPANY | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | DELTA DENTAL OF ILLINOIS | $6K | — | $6K | 7.37% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA WINE SERGI & | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 11.63% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | VISION SERVICE PLAN | $563 | — | $563 | 7.63% |
| WINE SERGI & CO LLC3 Filed as: WINE SERGI & COMPANY, LLC | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | VISION SERVICE PLAN | $56 | — | $56 | 0.76% |
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 | 161 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 183 | $1.1M |
| Dental | DELTA DENTAL OF ILLINOIS | 105 | $76K |
| Vision | VISION SERVICE PLAN | 84 | $7K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 161 | $31K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 161 | $31K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 161 | $31K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 161 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 183 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.