| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROFESSIONAL BENEFIT ADMINISTRATORS3 | 900 JORIE BLVD, STE 250 OAKBROOK, IL 60523 | PROFESSIONAL BENEFIT ADMINISTRATORS | — | $118K | $118K | 18.15% |
| USI INSURANCE SERVICES LLC3 | 200 SUMMIT LAKE DRIVE, SUITE 350 VALHALLA, NY 10595 | UNIMERICA INSURANCE COMPANY | — | $24K | $24K | 4.00% |
| DELTA INSURANCE AGENCY3 Filed as: DELTA DENTAL OF ILLINOIS | 111 SHUMAN BLVD NAPERVILLE, IL 60563 | DELTA DENTAL OF ILLINOIS | $0 | $0 | $0 | 0.00% |
| USI INSURANCE SERVICES LLC3 | 500 WABASH AVE TERRE HAUTE, IN 47807 | SUN LIFE ASSURANCE COMPANY OF CANADA | $6K | — | $6K | 6.95% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $942 | — | $942 | 1.06% |
| JAMES D CROSE3 | PO BOX 761 DANVILLE, IL 61834 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.26% |
| LINDA L HAWKINS3 | 505 12TH AVENUE WEST MILAN, IL 61264 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $483 | — | $483 | 1.20% |
| SANFORD GARY GOLDBERG3 | 222 GOOD HOPE ST CAPE GIRARDEAU, MO 63703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $472 | — | $472 | 1.17% |
| JOHN W NISWONGER3 | 525 COUNTY ROAD 233 CAPE GIRARDEAU, MO 63701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $340 | — | $340 | 0.84% |
| LISA D NISWONGER3 | 2711 THOMAS DRIVE CAPE GIRARDEAU, MO 63701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $240 | — | $240 | 0.60% |
| JOSEPH NISWONGER3 | 787 VAIL DRIVE JACKSON, MO 63755 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $68 | — | $68 | 0.17% |
| USI INSURANCE SERVICES LLC3 | PO BOX 900 TERRE HAUTE, IN 47808 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $60 | $1 | $61 | 0.15% |
| LAWRENCE A SCHRADER3 | 5631 CHALET FOREST DRIVE ST LOUIS, MO 63129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | — | $36 | 0.09% |
| CAROLYN REZNICEK3 | 24290 BUCKHORN LANE CARLINVILLE, IL 62626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.07% |
| DAVID ALLEN GONCHER3 | 234 BROADWAY CAPE GIRAREAU, MO 63701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.06% |
| LAURA A RHEIN3 | 101 SCHLUETER GERMAINE ROAD BELLEVILLE, IL 62220 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.04% |
| JO ANN PANTALONE3 Filed as: ANN M WEST | 1600 MIDAMERICA ST., UNIT 1613 PERRYVILLE, MO 63775 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.04% |
| VOLUNTARY BENEFIT PLANS LLC3 | 7474 DANVERS CIR PORT CHARLOTTE, FL 33981 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.03% |
| UVETA MATTHEWS NEWCOMER3 | C/O UVETA MATTHEWS NEWCOMER POPLAR BLUFF, MO 63901 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.03% |
| KAMI L STANLEY3 | 4520 S 49TH STREET LINCOLN, NE 68516 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.01% |
| ROGLE INC3 | 7460 LANTERN ROAD INDIANAPOLIS, IN 46256 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.01% |
| RICHARD C LANDMANN3 | 14823 CONWAY ROAD CHESTERFIELD, MO 63017 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 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 | 209 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | 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 | 200 | $649K |
| Dental | DELTA DENTAL OF ILLINOIS | 156 | $106K |
| Vision | DELTA DENTAL OF ILLINOIS | 156 | $106K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 211 | $129K |
| Short-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 211 | $129K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 211 | $89K |
| Prescription drug | PROFESSIONAL BENEFIT ADMINISTRATORS | 200 | $649K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | PROFESSIONAL BENEFIT ADMINISTRATORS | 202 | $1.2M |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 211 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 211 | — |
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.