| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROFESSIONAL BENEFIT ADMINISTRATORS | 900 JORIE BLVD., STE 250 OAK BROOK, IL 60523 | PROFESSIONAL BENEFIT ADMINISTRATION | $0 | $87K | $87K | 14.73% |
| JAMES D CROSE3 | PO BOX 761 DANVILLE, IL 61834 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $0 | $6K | 5.30% |
| SANFORD GARY GOLDBERG3 Filed as: SANFORD GARY GOLDBURG | 17A S SPANISH CAPE GIRARDEAU, MO 63701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $887 | $4K | 3.74% |
| CURTIS R HAWKINS3 | 220 HANEY ROAD CARBONDALE, IL 62901 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 2.37% |
| JOHN W NISWONGER3 | 525 COUNTY ROAD 233 CAPE GIRARDEAU, MO 63701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $185 | $2K | 1.55% |
| LISA D NISWONGER3 | 2711 THOMAS DR CAPE GIRARDEAU, MO 63701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $95 | $1K | 1.09% |
| JOSEPH NISWONGER3 | 787 VAIL DRIVE JACKSON, MO 63755 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $624 | $223 | $847 | 0.80% |
| JO ANN PANTALONE3 Filed as: ANN M WEST | 3377 B HIGHWAY E PERRYVILLE, MO 63775 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $235 | $16 | $251 | 0.24% |
| LAWRENCE A SCHRADER3 | 5631 CHALET FOREST DRIVE ST LOUIS, MO 63129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $179 | $0 | $179 | 0.17% |
| CAROLYN REZNICEK3 | 24290 BUCKHORN LANE CARLINVILLE, IL 62626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $70 | $0 | $70 | 0.07% |
| UVETA MATTHEWS NEWCOMER3 | C/O UVETA MATTHEWS NEWCOMER POPLAR BLUFF, MO 63901 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $35 | $0 | $35 | 0.03% |
| RONALD DOYLE3 | 317 EVERGREEN DRIVE HERRIN, IL 62948 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | $0 | $24 | 0.02% |
| CAROL A CUTTER3 | 624 GRIFFIN ROAD INDIANAPOLIS, IN 46227 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.00% |
| RICHARD C LANDMANN3 | 14823 CONWAY ROAD CHESTERFIELD, MO 63017 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.00% |
| CROSE INSURANCE AGENCY3 | PO BOX 761 DANVILLE, IL 61834 | DELTA DENTAL OF ILLINOIS | $719 | $0 | $719 | 0.69% |
| R W GARRETT AGENCY3 Filed as: RW GARRETT AGENCY | 2201 WOODLAWN ROAD PO BOX 370 LINCOLN, IL 626560370 | DEARBORN NATIONAL | $2K | $858 | $3K | 20.38% |
| GROUP MARKETING SERVICES INC3 | 2201 WOODLAWN ROAD LINCOLN, IL 626569645 | DEARBORN NATIONAL | $0 | $639 | $639 | 4.00% |
| PROFESSIONAL BENEFIT ADMINISTRATION3 | 900 JORIE BLVD., STE 250 OAK BROOK, IL 60523 | STANDARD SECURITY LIFE | $5K | $147 | $5K | — |
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 | 208 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 208 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROFESSIONAL BENEFIT ADMINISTRATION | 208 | $590K |
| Dental | DELTA DENTAL OF ILLINOIS | 146 | $104K |
| Vision | DELTA DENTAL OF ILLINOIS | 146 | $104K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 196 | $122K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 196 | $122K |
| Prescription drug | PROFESSIONAL BENEFIT ADMINISTRATION | 208 | $590K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | PROFESSIONAL BENEFIT ADMINISTRATION | 208 | $590K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 208 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.