| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WINE SERGI & CO LLC3 Filed as: WINE SERGI & COMPANY, LLC | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | BLUECROSS BLUESHIELD OF ILLINOIS | $72K | $1K | $73K | 3.78% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA WINE SERGI & | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | $8K | — | $8K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA WINE SERGI & | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 10.59% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA WINE SERGI & | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 16.02% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | VISION SERVICE PLAN | $992 | — | $992 | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA WINE SERGI & | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 16.30% |
| WINE SERGI & CO LLC3 | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $94 | — | $94 | 1.42% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC DBA WINE SERGI & CO | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $139 | — | $139 | 3.17% |
| WINE SERGI & CO LLC3 | 1000 E WARRENVILLE RD STE 101 NAPERVILLE, IL 60563 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $125 | — | $125 | 2.85% |
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 | 315 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 316 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 414 | $1.9M |
| Dental | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | 69 | $84K |
| Vision | VISION SERVICE PLAN | 111 | $10K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 314 | $26K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 13 | $7K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 16 | $7K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 314 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 414 | — |
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.