| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $4K | $11K | 19.69% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: ASSURANCE, A MARSH & MCLENNAN AGCY | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | EYEMED VISION CARE | $1K | $0 | $1K | 8.50% |
| ASSURANCE AGENCY LTD3 | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 12.69% |
| KME INSURANCE BROKERAGE, INC.3 Filed as: KME INSURANCE BROKERAGE INC | 125 S WACKER DR., STE. 300 CHICAGO, IL 60606 | PRINCIPAL LIFE INSURANCE COMPANY | $955 | $0 | $955 | 7.33% |
| ASSURANCE AGENCY LTD3 | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 16.36% |
| KME INSURANCE BROKERAGE, INC.3 Filed as: KME INS BROKERAGE INC | 125 S WACKER DR, STE 300 CHICAGO, IL 60606 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 13.45% |
| MARSH & MCLENNAN AGENCY LLC3 | 20 N. MARTINGALE RD., STE. 100 SCHAUMBURG, IL 60173 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $25 | $1K | 13.25% |
| DEBRA POCZATKO3 Filed as: DEBRA RENEE BARCH | 14466 S ELIZABETH LANE HOMER GLEN, IL 60491 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $264 | $25 | $289 | 3.14% |
| HENRY J SAMAAN3 Filed as: HENRY JACOB SAMAAN | 19W152 21ST PLACE LOMBARD, IL 60148 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $175 | $3 | $178 | 1.93% |
| GERALD A GREENEN3 | 472 ROUTE 47 STE F-102 SUGAR GROVE, IL 60554 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $114 | $57 | $171 | 1.86% |
| HOWARD HOROWITZ3 Filed as: HOWARD J HOROWITZ | 2610 ALCOTT STREET CARMEL, IN 46032 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $64 | $6 | $70 | 0.76% |
| YESENIA A SANCHEZ3 Filed as: YESENIA A HERNANDEZ | 6715 S KEELER AVE CHICAGO, IL 60629 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $40 | $3 | $43 | 0.47% |
| MONICA L LEIVA3 | 556 N ARTESIAN AVE CHICAGO, IL 60612 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $43 | $0 | $43 | 0.47% |
| VALUE ADDED SOLUTIONS3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $17 | $37 | 0.40% |
| JANTELLE LAVONNE BONNER3 | 99 N POST OAK LANE, APT 5302 HOUSTON, TX 77024 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $27 | $0 | $27 | 0.29% |
| ELAISIUS BONNER3 | 974 ROSEFIELD LANE AURORA, IL 60504 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $13 | $0 | $13 | 0.14% |
| TEKAYLA WORKS3 | 115 VILLAGE BEND DRIVE ALEXANDER, AR 72002 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | $0 | $5 | 0.05% |
| REBECCA STERNBERG3 | 374 MILFORD RD DEERFIELD, IL 60015 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | $0 | $5 | 0.05% |
| MICHAEL BLOCK3 | 41 ARUM CT ST AUGUSTINE, FL 32095 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
| NORMAC SOLUTIONS INC3 | 449 HOPKINS ROAD TOWNVILLE, SC 29689 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
| JCASTELLANOS AND ASSOCIATES INC3 | 7441 FIGURA DRIVE JUSTICE, IL 60458 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
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 | 110 | 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) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE | 150 | $13K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 107 | $58K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 107 | $58K |
| Long-term disability(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 107 | $81K |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 165 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 165 | — |
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.