| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL SMITH3 Filed as: MICHAEL A SMITH | 43W444 SCOTT RD SUGAR GROVE, IL 60554 | BLUECROSS BLUESHIELD OF ILLINOIS | $57K | — | $57K | 3.91% |
| MICHAEL SMITH3 | 43W444 SCOTT RD SUGAR GROVE, IL 60554 | DELTA DENTAL OF ILLINOIS | $6K | — | $6K | 7.50% |
| SMITH, MICHAEL A3 | 43W444 SCOTT RD SUGAR GROVE, IL 60554 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 13.80% |
| SMITH, MICHAEL A3 | PO BOX 164 SUGAR GROVE, IL 60554 | DEARBORN LIFE INSURANCE COMPANY | $2K | — | $2K | 11.03% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: EMPLOYEE BENEFITS RISK MGMT | 823 COMMERCE DR #350 OAK BROOK, IL 60523 | DEARBORN LIFE INSURANCE COMPANY | — | $840 | $840 | 5.01% |
| SMITH, MICHAEL A3 | 43W444 SCOTT RD SUGAR GROVE, IL 60554 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 13.02% |
| MICHAEL SMITH3 | PO BOX 164 SUGAR GROVE, IL 60554 | VISION SERVICE PLAN | $725 | — | $725 | 7.63% |
| SMITH, MICHAEL A3 | 43W444 SCOTT RD SUGAR GROVE, IL 60554 | UNUM INSURANCE COMPANY | $1K | — | $1K | 13.79% |
| SMITH, MICHAEL A3 | 43W444 SCOTT RD SUGAR GROVE, IL 60554 | UNUM INSURANCE COMPANY | $671 | — | $671 | 10.91% |
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 | 137 | 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) | 137 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 153 | $1.5M |
| Dental | DELTA DENTAL OF ILLINOIS | 104 | $80K |
| Vision | VISION SERVICE PLAN | 82 | $10K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 137 | $39K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 19 | $15K |
| Other(4 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 137 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 153 | — |
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.