| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES INC | 700 WEST 47TH STREET SUITE 1100 KANSAS CITY, MO 64112 | UNITEDHEALTHCARE INSURANCE COMPANY | $54K | $3K | $58K | 4.11% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: INSENTIAL INC | 206 SOUTH JEFFERSON STREET SUITE 200 CHICAGO, IL 60661 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $13K | — | $13K | 15.00% |
| NICHOLAS DEAN POTTHOFF3 | 110 E MAIN ST STE 220 OTTAWA, IL 61350 | NORTHWESTERN MUTUAL | $1K | $316 | $2K | 8.26% |
| CHET DOUGLAS BANDY3 | 1600 HUNT DR NORMAL, IL 61761 | NORTHWESTERN MUTUAL | $228 | $54 | $282 | 1.38% |
| MCCLURE FNCL GROUP INC3 | 301 N NEIL ST STE 501 CHAMPAIGN, IL 61820 | NORTHWESTERN MUTUAL | $203 | $18 | $221 | 1.08% |
| NICHOLAS DEAN POTTHOFF3 | 110 E MAIL ST STE 220 OTTAWA, IL 61350 | NORTHWESTERN MUTUAL | $1K | $299 | $2K | 16.61% |
| CHET DOUGLAS BANDY3 | 1600 HUNT DR NORMAL, IL 61761 | NORTHWESTERN MUTUAL | $216 | $51 | $267 | 2.78% |
| MCCLURE FNCL GROUP INC3 Filed as: MCCLURE FINANCIAL GROUP INC | 301 N NAIL ST STE 501 CHAMPAIGN, IL 61820 | NORTHWESTERN MUTUAL | $192 | $17 | $209 | 2.18% |
| HORIZON INSURANCE & ASSOC3 | PO BOX 1561 BLOOMINGTON, IL 61702 | HUMANA INSURANCE COMPANY | $941 | — | $941 | 14.44% |
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 | 129 | 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) | 129 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 278 | $1.4M |
| Dental | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 119 | $85K |
| Life insurance | HUMANA INSURANCE COMPANY | 124 | $7K |
| Short-term disability | NORTHWESTERN MUTUAL | 112 | $20K |
| Long-term disability | NORTHWESTERN MUTUAL | 112 | $10K |
| Other | HUMANA INSURANCE COMPANY | 124 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 278 | — |
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.