| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROFESSIONAL BENEFIT ADMINISTRATORS3 | 900 JORIE BLVD, STE 250 OAK BROOK, IL 60523 | PROFESSIONAL BENEFIT ADMINISTRATORS | $0 | $118K | $118K | 13.93% |
| PROFESSIONAL BENEFIT ADMINISTRATORS3 | 900 JORIE BLVD, STE 250 OAK BROOK, IL 60523 | WESTPORT INSURANCE CORPORATION | $6K | $0 | $6K | 0.78% |
| USI INSURANCE SERVICES LLC3 | 500 WABASH AVENUE TERRE HAUTE, IN 47807 | SUN LIFE ASSURANCE COMPANY OF CANADA | $10K | $0 | $10K | 10.83% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 1.17% |
| DELTA INSURANCE AGENCY3 Filed as: DELTA DENTAL OF ILLINOIS | 111 SHUMAN BLVD NAPERVILLE, IL 60563 | DELTA DENTAL OF ILLINOIS | $0 | $0 | $0 | 0.00% |
| JAMES D CROSE3 | PO BOX 761 DANVILLE, IL 61834 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 2.78% |
| SANFORD GARY GOLDBERG3 | 17A SPANISH CAPE FIRARDEAU, MO 63701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $527 | $0 | $527 | 1.06% |
| CURTIS R HAWKINS3 | 220 HANEY ROAD CARBONDALE, IL 62901 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $379 | $0 | $379 | 0.76% |
| JOHN W NISWONGER3 | 525 COUNTY ROAD 233 CAPE GIRARDEAU, MO 63701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $361 | $0 | $361 | 0.73% |
| LISA D NISWONGER3 Filed as: LISA NISWONGER | 2711 THOMAS DRIVE CAPE GIRARDEAU, MO 63701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $263 | $0 | $263 | 0.53% |
| LINDA L HAWKINS3 | 505 12TH AVENUE WEST MILAN, IL 61264 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $102 | $0 | $102 | 0.20% |
| JOSEPH NISWONGER3 | 787 VAIL DRIVE JACKSON, MO 63755 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $78 | $0 | $78 | 0.16% |
| USI INSURANCE SERVICES LLC3 | PO BOX 900 TERRE HAUTE, IN 47808 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $50 | $4 | $54 | 0.11% |
| DAVID ALLEN GONCHER3 | 234 BROADWAY CAPE GIRARDEAU, MO 63701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $51 | $0 | $51 | 0.10% |
| LAWRENCE A SCHRADER3 | 5631 CHALET FOREST DRIVE ST. LOUIS, MO 63129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $37 | $0 | $37 | 0.07% |
| CAROLYN REZNICEK3 | 24290 BUCKHORN LANE CARLINVILLE, IL 62626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $0 | $26 | 0.05% |
| VOLUNTARY BENEFIT PLANS LLC3 | PO BOX 51590 INDIANAPOLIS, IN 46251 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | $0 | $18 | 0.04% |
| UVETA MATTHEWS NEWCOMER3 | C/O UVETA MATHEWS NEWCOMER POPLAR BLUFFS, MO 63901 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 0.03% |
| ROGLE INC3 | 2108 N. PENNSYLVANIA ST INDIANAPOLIS, IN 46202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $4 | $7 | 0.01% |
| KAMI L STANLEY3 | 4520 S 49TH STREET LINCOLN, NE 68516 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.01% |
| RICHARD C LANDMANN3 | 14823 CONWAY ROAD CHESTERFIELD, MO 63017 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.00% |
| DELTA INSURANCE AGENCY3 Filed as: DELTA DENTAL OF ILLINOIS | 111 SHUMAN BLVE NAPERVILLE, IL 60563 | PROTECH INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PROFESSIONAL BENEFIT ADMINISTRATORS EIN 36-3384135 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | 900 JORIE BLVD, STE 250 OAK BROOK, IL 60523 | $118K |
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 | 210 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 211 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROFESSIONAL BENEFIT ADMINISTRATORS | 211 | $847K |
| Dental | DELTA DENTAL OF ILLINOIS | 166 | $86K |
| Vision | PROTECH INSURANCE COMPANY | 147 | $16K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 225 | $145K |
| Short-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 225 | $145K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 225 | $96K |
| Prescription drug | PROFESSIONAL BENEFIT ADMINISTRATORS | 211 | $847K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | PROFESSIONAL BENEFIT ADMINISTRATORS | 211 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 225 | — |
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.