| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL A SMITH3 | 43W444 SCOTT RD SUGAR GROVE, IL 60554 | BLUECROSS BLUESHIELD OF ILLINOIS | $53K | — | $53K | 3.93% |
| MICHAEL A SMITH3 Filed as: MICHAEL SMITH | 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 | 15.00% |
| SMITH, MICHAEL A3 | PO BOX 164 SUGAR GROVE, IL 60554 | DEARBORN LIFE INSURANCE COMPANY | $2K | — | $2K | 11.96% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: EMPLOYEE BENEFITS RISK MGMT | 823 COMMERCE DR #350 OAK BROOK, IL 60523 | DEARBORN LIFE INSURANCE COMPANY | — | $1K | $1K | 6.89% |
| SMITH, MICHAEL A3 | 43W444 SCOTT RD SUGAR GROVE, IL 60554 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 15.00% |
| MICHAEL A SMITH3 Filed as: MICHAEL SMITH | PO BOX 164 SUGAR GROVE, IL 60554 | VISION SERVICE PLAN | $715 | — | $715 | 7.68% |
| SMITH, MICHAEL A3 | 43W444 SCOTT RD SUGAR GROVE, IL 60554 | UNUM INSURANCE COMPANY | $1K | — | $1K | 16.39% |
| SMITH, MICHAEL A3 | 43W444 SCOTT RD SUGAR GROVE, IL 60554 | UNUM INSURANCE COMPANY | $589 | — | $589 | 11.39% |
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 | 127 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 133 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 150 | $1.3M |
| Dental | DELTA DENTAL OF ILLINOIS | 98 | $75K |
| Vision | VISION SERVICE PLAN | 77 | $9K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 132 | $33K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 22 | $13K |
| Other(4 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 132 | $46K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 150 | — |
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.