| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEMENS & ASSOCIATES LIFE AGENCY3 | 2806 EAST EMPIRE STREET BLOOMINGTON, IL 61704 | BLUECROSS BLUESHIELD OF ILLINOIS | $64K | $4K | $68K | 2.08% |
| CLEMENS & ASSOCIATES LIFE AGENCY3 | 2806 EAST EMPIRE STREET BLOOMINGTON, IL 61704 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | — | $4K | 2.04% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SVCS, INC | PO BOX 28 DUBUQUE, IA 52004 | METROPOLITAN LIFE INSURANCE COMPANY | $851 | $3K | $4K | 2.03% |
| CLEMENS & ASSOCIATES LIFE AGENCY3 | 2806 EAST EMPIRE STREET BLOOMINGTON, IL 61704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 5.04% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SVCS, INC | PO BOX 28 DUBUQUE, IA 52004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $690 | — | $690 | 0.85% |
| CLEMENS & ASSOCIATES LIFE AGENCY3 | 2806 EAST EMPIRE STREET BLOOMINGTON, IL 61704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 5.80% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SVCS, INC | PO BOX 28 DUBUQUE, IA 52004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $260 | — | $260 | 0.33% |
| CLEMENS & ASSOCIATES LIFE AGENCY3 | 2806 EAST EMPIRE STREET BLOOMINGTON, IL 61704 | VISION SERVICE PLAN | $1K | — | $1K | 3.26% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SVCS, INC | PO BOX 28 DUBUQUE, IA 52004 | VISION SERVICE PLAN | $342 | — | $342 | 0.88% |
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 | 470 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 473 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 860 | $3.3M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 1,156 | $186K |
| Vision | VISION SERVICE PLAN | 347 | $39K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 373 | $81K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 351 | $78K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,156 | — |
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.