| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEMENS & ASSOCIATES LIFE AGENCY3 Filed as: CLEMENS & ASSOC LIFE AGCY LTD | PO BOX 217 2806 E EMPIRE ST BLOOMINGTON, IL 61702 | AFLAC | $2K | — | $2K | 4.38% |
| JANE E CLEMENS3 | 11530 FREESIA RD MOUNT VERNON, IL 62864 | AFLAC | $2K | — | $2K | 2.81% |
| KENNETH J CREWS3 | 3306 W LAKEVIEW RD MARION, IL 62959 | AFLAC | $703 | $149 | $852 | 1.59% |
| JASON E COX3 | 495 TUNNEL VALLEY LN TUNNEL HILL, IL 62972 | AFLAC | $693 | $150 | $843 | 1.57% |
| H BRIAN GIBSON3 | 105 ZURIC CT NASHVILLE, TN 37221 | AFLAC | $707 | — | $707 | 1.32% |
| GARRETT WILSON3 | 5527 BRENTWOOD RD KARNAK, IL 62956 | AFLAC | $530 | $60 | $590 | 1.10% |
| TIMOTHY J REED3 Filed as: TIMOTHY S INGRAM | 1731 MOUNT ZION RD JACKSONVILLE, IL 62650 | AFLAC | $357 | $60 | $417 | 0.78% |
| CAROLYN J HINKLE3 | 1372 COUNTY ROAD 2200 E FAIRFIELD, IL 62837 | AFLAC | $234 | — | $234 | 0.44% |
| TARA M JORDAN3 | 800 LAKESHORE DR TUSCOLA, IL 61953 | AFLAC | $173 | — | $173 | 0.32% |
| TROY OWENS3 Filed as: TROY STEPHEN OWENS | 238 MADISON ST KINMUNDY, IL 62854 | AFLAC | $156 | — | $156 | 0.29% |
| JAMES D COCKBURN3 Filed as: JAMES R KOSCO | 301 INDIAN DR JOHNSTON CITY, IL 62951 | AFLAC | $99 | — | $99 | 0.18% |
| TRAVIS COCKBURN3 Filed as: TRAVIS J COCKBURN | PO BOX 335 JOHNSTON CITY, IL 62951 | AFLAC | $83 | — | $83 | 0.15% |
| JASON HOFFARD3 Filed as: JASON T HOFFARD | 3415 OFFICE PARK DR STE C MARIAN, IL 62959 | AFLAC | $80 | — | $80 | 0.15% |
| SHARYL K BATHE3 Filed as: SHARYL K JUNEAU | 620 ODD FELLOW RD MATTOON, IL 61938 | AFLAC | $80 | — | $80 | 0.15% |
| FRANK A HAMILTON3 | 9504 BRIGHTON BUNKER HILL RD BUNKER HILL, IL 62014 | AFLAC | $74 | — | $74 | 0.14% |
| JONI L BARBRE3 | 607 N EPWORTH ST FAIRFIELD, IL 62837 | AFLAC | $53 | — | $53 | 0.10% |
| AMBER NICOLE ARNOLD3 | 10 DAVID DR SAINT JACOB, IL 62281 | AFLAC | $50 | — | $50 | 0.09% |
| LINDA WHEAT3 Filed as: LINDA J WHEAT | 507 HORSESHOE LN CASEY, IL 62420 | AFLAC | $48 | — | $48 | 0.09% |
| TERRY J SILVERS3 | 100 GREENLEAF DR FLAT ROCK, NC 28731 | AFLAC | $47 | — | $47 | 0.09% |
| DAVID HENDERSON3 Filed as: DAVID M HENDERSON | 2351 CRESCENT HILL DR OWENSBORO, KY 42303 | AFLAC | $38 | — | $38 | 0.07% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BRUCE N BROWN | 7540 OLD HIGHWAY 50 FLORA, IL 62839 | AFLAC | $35 | — | $35 | 0.07% |
| STEPHEN B THACKSTON3 | 200 W 10TH ST BAY MINETTE, AL 36507 | AFLAC | $35 | — | $35 | 0.07% |
| DEVIN PEGRAM BALL3 | 536 TEAL DR CHATHAM, IL 62629 | AFLAC | $33 | — | $33 | 0.06% |
| GK JOHNSON INC3 | 326 HOLLOW OAK DR UNIT B SUMMERVILLE, SC 29486 | AFLAC | $21 | — | $21 | 0.04% |
| GARY A EBERLIN3 | 3415 MAPLE RIDGE DR WOOD RIVER, IL 62095 | AFLAC | $18 | — | $18 | 0.03% |
| GARY W WARE JR3 | 3103 MEADOWBROOK DR CHAMPAIGN, IL 61822 | AFLAC | $17 | — | $17 | 0.03% |
| JAMES D COCKBURN3 | 16216 HARRIS SCHOOL DD JOHNSTON CITY, IL 62951 | AFLAC | $16 | — | $16 | 0.03% |
| ROBERT D WAKE3 | PO BOX 87 WASHINGTON, IN 47501 | AFLAC | $13 | — | $13 | 0.02% |
| JORDAN LYNN FUNK3 | 917 COUNTY ROAD 100 N THOMPSONVILLE, IL 62890 | AFLAC | $13 | — | $13 | 0.02% |
| JEREMY S KLOKKENGA3 | 20097 SHAKER LAKE RD BLOOMINGTON, IL 61705 | AFLAC | $11 | — | $11 | 0.02% |
| BRUCE ROBERT HARRIS3 Filed as: BRUCE R HARRIS | 1011 HERBERT ST MOUNT VERNON, IL 62864 | AFLAC | $9 | — | $9 | 0.02% |
| CHRISTIE MARZARI3 Filed as: CHRISTIE M MARZARI | 3343 LANELL LN PEARL, MS 39208 | AFLAC | $8 | — | $8 | 0.01% |
| ACRISURE LLC3 Filed as: ACRISURE TEXAS RISK ADVISORS & INS | PO BOX 84 HARRISBURG, IL 62946 | AFLAC | $7 | — | $7 | 0.01% |
| JOHN D TYLER3 | 2131 KILEY WAY EDMOND, OK 73034 | AFLAC | $5 | — | $5 | 0.01% |
| BRIAN R KIMMEL3 | 309 BRAESWICK DR LAKE ST LOUIS, MO 63367 | AFLAC | $4 | — | $4 | 0.01% |
| TAMMY KILGORE3 Filed as: TAMMY L KILGORE | 2209 BELLA FIORE LN PONTIAC, IL 61764 | AFLAC | $4 | — | $4 | 0.01% |
| MARTHA MONCKTON3 Filed as: MARTHA S MONCKTON | 2411 E GRANDVIEW AVE PEORIA, IL 61614 | AFLAC | $3 | — | $3 | 0.01% |
| WILLIAM B KRZCIOK3 | 2760 FORT MYER AVE HENDERSON, NV 89052 | AFLAC | $3 | — | $3 | 0.01% |
| ROSANNE GARNER3 | 203 N CEDAR ST BONE GAP, IL 62815 | AFLAC | $2 | — | $2 | 0.00% |
| JAMES M BROCK3 Filed as: JAMES MARK BROCK | 3116 WILLIAMSON COUNTY PKWY MARION, IL 62959 | AFLAC | $2 | — | $2 | 0.00% |
| GEORGE P OWENS3 | 653 N ANTLER DR MT ZION, IL 62549 | AFLAC | $1 | — | $1 | 0.00% |
| JAMES M FLETCHER3 | 7325 CLUBHOUSE DR FORT WAYNE, IN 46835 | AFLAC | $1 | — | $1 | 0.00% |
| JOSEPH L LEDOUX3 | 2411 CARTER AVE NASHVILLE, TN 37206 | AFLAC | $1 | — | $1 | 0.00% |
| GREGORY J SHARP3 | 702 E 5TH ST COAL VALLEY, IL 61240 | AFLAC | $1 | — | $1 | 0.00% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AFLAC | 104 | $54K |
| Short-term disability | AFLAC | 104 | $54K |
| Other | AFLAC | 104 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 104 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.