| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | BLUE CROSS BLUE SHIELD HEALTHCARE OF GEORGIA INC | $62K | — | $62K | 3.72% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 | PO BOX 9201 AUSTIN, TX 78766 | METROPOLITAN LIFE INSURANCE CO | $25K | -$4K | $21K | 23.69% |
| ASSURANCE AGENCY LTD3 | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | METROPOLITAN LIFE INSURANCE CO | $2K | $200 | $2K | 2.43% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE CO | — | $1K | $1K | 1.24% |
| ASSURANCE AGENCY LTD3 | 20 N MARTINGALE RD STE 100 SCHAMBURG, IL 601732423 | METROPOLITAN LIFE INSURANCE CO | — | $55 | $55 | 0.06% |
| ASSURANCE AGENCY LTD3 | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | METROPOLITAN LIFE INSURANCE CO | $2K | $27 | $2K | 18.53% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE CO | $396 | $50 | $446 | 5.13% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON CHAPMAN BENEFIT ADM. | PO BOX 9201 AUSTIN, TX 78766 | METROPOLITAN LIFE INSURANCE CO | — | $396 | $396 | 4.55% |
| ASSURANCE AGENCY LTD3 | 20 N MARTINGALE RD STE 100 SCHAMBURG, IL 601732423 | METROPOLITAN LIFE INSURANCE CO | — | $74 | $74 | 0.85% |
| ASSURANCE AGENCY LTD3 | 20 N. MARTINGALE RD., STE 100 SCHAUMBURG, IL 60173 | METROPOLITAN LIFE INSURANCE CO | $1K | $27 | $1K | 18.83% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE CO | $332 | $54 | $386 | 5.36% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON CHAPMAN BENEFIT ADM. | PO BOX 9201 AUSTIN, TX 78766 | METROPOLITAN LIFE INSURANCE CO | — | $332 | $332 | 4.61% |
| ASSURANCE AGENCY LTD3 | 20 N MARTINGALE RD STE 100 SCHAMBURG, IL 601732423 | METROPOLITAN LIFE INSURANCE CO | — | $48 | $48 | 0.67% |
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 | 428 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 434 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD HEALTHCARE OF GEORGIA INC | 313 | $1.7M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 428 | $279K |
| Vision(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 428 | $279K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 428 | $279K |
| Short-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 428 | $279K |
| Long-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 428 | $279K |
| Other(4 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 428 | $295K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 428 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.