| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WEIS INSURANCE AGENCY LLC3 Filed as: WEIS INSURANCE AGENCY, LLC | 2101 S. BANKER STREET EFFINGHAM, IL 62401 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $75K | $1K | $76K | 3.93% |
| WEIS INSURANCE AGENCY LLC3 Filed as: WEIS INSURANCE AGENCY, LLC | 2101 S. BANKER STREET EFFINGHAM, IL 62401 | DEARBORN LIFE INSURANCE COMPANY | $12K | $0 | $12K | 12.45% |
| WEIS INSURANCE AGENCY LLC3 | 2101 S. BANKER ST. EFFINGHAM, IL 62401 | SUN LIFE ASSURANCE COMPANY OF CANADA | $524 | $0 | $524 | 21.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SUN LIFE ASSURANCE COMPANY OF CANAD EIN 38-1082080 NONE | Other commissions; Claims processing; Other fees; Insurance agents and brokers Service code 12 | 2323 GRAND BLVD. KANSAS CITY, MO 64108 | $67K |
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 | 143 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 314 | $1.9M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 142 | $2K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 143 | $93K |
| Long-term disability | DEARBORN LIFE INSURANCE COMPANY | 143 | $93K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ILLINOIS | 314 | $1.9M |
| Other | DEARBORN LIFE INSURANCE COMPANY | 143 | $93K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 314 | — |
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.