| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL,INC | 1787 SENTRY PKWY W SUITE 300 BLUE BELL, PA 194222240 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $22K | — | $22K | 1.46% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 234661007 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $8K | — | $8K | 0.51% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST | 312 ELM ST STE #2200 CINCINATTI, OH 45202 | BLUE CROSS BLUE SHIELD OF ILLINOIS | — | $2K | $2K | 0.11% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 | PO BOX 9201 AUSTIN, TX 787669201 | METROPOLITAN LIFE INSURANCE COMPANY | $25K | $6K | $31K | 20.73% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS | 422 WAUPONSEE ST MORRIS, IL 604502215 | METROPOLITAN LIFE INSURANCE COMPANY | — | $3K | $3K | 1.87% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 234661007 | METROPOLITAN LIFE INSURANCE COMPANY | — | $802 | $802 | 0.54% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 1787 SENTRY PKWY W STE 300 BLUE BELL, PA 194222240 | METROPOLITAN LIFE INSURANCE COMPANY | — | $468 | $468 | 0.31% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 800 NORMAN CENTER DR STE 400 BLOOMINGTON, MN 554371180 | METROPOLITAN LIFE INSURANCE COMPANY | — | $41 | $41 | 0.03% |
| MICHAEL C WALKER3 Filed as: MICHAEL PETERS | 3308 W SPRINGIELD AVE SUITE D CHAMPAIGN, IL 61822 | ASSURITY LIFE INSURANCE COMPANY | $4K | — | $4K | 8.43% |
| GARY WOOD ASSOCIATES, INC.3 Filed as: GARY WARE AND ASSOCIATES | 3808 W SPRINGFIELD AVE SUITE D CHAMPAIGN, IL 61822 | ASSURITY LIFE INSURANCE COMPANY | $3K | — | $3K | 6.92% |
| MICHAEL PETERS & ASSOCIATES, INC.3 Filed as: MICHAEL PETERS ASSOCIATES | 3808 W SPRINGFIELD AVE SUITE D CHAMPAIGN, IL 61822 | ASSURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 2.97% |
| MICHAEL C WALKER3 Filed as: MICHAEL PETERS | 3808 W SPRINGFIELD AVE SUITE D CHAMPAIGN, IL 61822 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $819 | — | $819 | 11.61% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SVCS NATIONAL INC | 2107 S NEIL ST CHAMPAIGN, IL 61820 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $716 | — | $716 | 10.15% |
| GARY W WARE JR3 Filed as: GARY WARE JR | 3808 W SPRINGFIELD AVE SUITE D CHAMPAIGN, IL 61822 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $691 | — | $691 | 9.80% |
| SCOTT REMOLE3 | 3808 W SPRINGFIELD AVE SUITE D CHAMPAIGN, IL 61822 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $174 | — | $174 | 2.47% |
| BENJAMIN MEYER3 | 3808 W SPRINGFIELD AVE SUITE D CHAMPAIGN, IL 61822 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $71 | — | $71 | 1.01% |
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 | 267 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 268 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 236 | $1.5M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 350 | $150K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 350 | $150K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 350 | $150K |
| Short-term disability | ASSURITY LIFE INSURANCE COMPANY | 160 | $47K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 350 | $150K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 350 | $157K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 350 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.