| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AXION RMS LTD3 | 2443 WARRENVILLE RD SUITE 610 LISLE, IL 60532 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $23K | $525 | $24K | 3.41% |
| AXION RMS LTD3 | 2443 WARRENVILLE RD SUITE 610 LISLE, IL 60532 | STANDARD INSURANCE COMPANY | $10K | — | $10K | 15.92% |
| THE JELLYVISION LAB, INC.3 Filed as: THE JELLYVISION LAB INC. | 848 W EASTMAN STE 104 CHICAGO, IL 60642 | STANDARD INSURANCE COMPANY | — | $2K | $2K | 2.75% |
| AXION RMS LTD3 | 2443 WARRENVILLE RD SUITE 610 LISLE, IL 60532 | EYEMED VISION CARE | $641 | — | $641 | 11.67% |
| THREEFLOW | 227 W MONROE STREET SUITE 5200 CHICAGO, IL 60606 | EYEMED VISION CARE | $58 | — | $58 | 1.06% |
| WATCH TOWER BENEFITS3 Filed as: WATCH TOWER | 227 W MONROE STREET SUITE 5200 CHICAGO, IL 60606 | EYEMED VISION CARE | $11 | — | $11 | 0.20% |
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 | 125 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 122 | $702K |
| Dental | STANDARD INSURANCE COMPANY | 125 | $61K |
| Vision | EYEMED VISION CARE | 81 | $5K |
| Life insurance | STANDARD INSURANCE COMPANY | 125 | $61K |
| Short-term disability | STANDARD INSURANCE COMPANY | 125 | $61K |
| Long-term disability | STANDARD INSURANCE COMPANY | 125 | $61K |
| Other | STANDARD INSURANCE COMPANY | 125 | $61K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 125 | — |
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.