| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROXANNE C MYERS3 Filed as: ROXANNE MYERS | — | HEALTH ALLIANCE MEDICAL PLANS | $54K | — | $54K | 2.91% |
| ROXANNE C MYERS3 | 5905 SOUTH CANTRALL CREEK ROAD CANTRALL, IL 62625 | AFLAC | $3K | — | $3K | 3.65% |
| KENNETH JACKSON3 Filed as: KENNETH A JACKSON | 1705 SANDUSKY ROAD JACKSONVILLE, IL 62650 | AFLAC | $2K | $358 | $3K | 2.81% |
| JENNIFER M ROSS3 | 9 KENDALL AVENUE BARRY, IL 62312 | AFLAC | $2K | — | $2K | 1.66% |
| BRENT L GOODE3 | 2000 GLEN ECHO ROAD SUITE 204 NASHVILLE, TN 37215 | AFLAC | $1K | — | $1K | 1.28% |
| JERRY DAILY3 | 105 WEST HIGHLAND MURRAYVILLE, IL 62668 | AFLAC | $784 | — | $784 | 0.85% |
| ANDREW JACKSON JR3 Filed as: ANDREW H JACKSON JR | PO BOX 155 GRAFTON, ID 62037 | AFLAC | $452 | $310 | $762 | 0.83% |
| GARY A EBERLIN3 | 3415 MAPLE RIDGE DRIVE WOODRIVER, IL 62095 | AFLAC | $626 | $60 | $686 | 0.75% |
| BENJAMIN M PONDER3 | 1111 WEST MORTON AVENUE SUITE 11 JACKSONVILLE, IL 62650 | AFLAC | $573 | $60 | $633 | 0.69% |
| J.D. ROSS AND ASSOCIATES, INC.3 Filed as: JD ROSS ASSOCIATES | 9 KENDALL AVENUE BARRY, ID 62312 | AFLAC | $577 | — | $577 | 0.63% |
| FRANK A HAMILTON3 | 9504 BRIGHTON BUNKER HILL ROAD BUNKER HILL, IL 62014 | AFLAC | $553 | — | $553 | 0.60% |
| CHRISTOPHER L ALTON3 | 150 NORTH MILLER ROAD SUITE 300A FAIRLAWN, OH 44333 | AFLAC | $419 | — | $419 | 0.46% |
| TRAVIS COCKBURN3 Filed as: TRAVIS J COCKBURN | 402 NORTH MAIN STREET BENTON, IL 62812 | AFLAC | $221 | $119 | $340 | 0.37% |
| JEREMY S KLOKKENGA3 | 1355 NORTH BLUFF ROAD SUITE A COLLINSVILLE, IL 62234 | AFLAC | $248 | $60 | $308 | 0.34% |
| DON J CONOYER3 | 303 HOGUE LANE WYLIE, TX 75098 | AFLAC | $244 | — | $244 | 0.27% |
| ELIZABETH M GASPAROVIC3 | 1531 WEST RUE JAMES PLACE PALATINE, IL 60067 | AFLAC | $242 | — | $242 | 0.26% |
| GARY W WARE JR3 | 2306 VALLEYBROOK DRIVE CHAMPAIGN, IL 61822 | AFLAC | $165 | — | $165 | 0.18% |
| MATHEW P GAHM3 | 6754 SILVERWIND CIRCLE COLORADO SPRINGS, CO 80923 | AFLAC | $127 | — | $127 | 0.14% |
| DAVID M CRUMLEY3 | 5111 MARYLAND WAY SUITE 210 BRENTWOOD, TN 37027 | AFLAC | $81 | — | $81 | 0.09% |
| TERRY J SILVERS3 | 100 GREENLEAF DRIVE FLAT ROCK, NC 28731 | AFLAC | $54 | — | $54 | 0.06% |
| SHELLY R STEINWAGNER3 | 3221 HILL ROAD HIGHLAND, IL 62249 | AFLAC | $22 | — | $22 | 0.02% |
| GARY E ZIMMER3 | 129 PINE STREET JACKSONVILLE, IL 62650 | AFLAC | $19 | — | $19 | 0.02% |
| MAUREEN DEPPE3 | PO BOX 2045 FAIRVIEW HEIGHTS, IL 62208 | AFLAC | $14 | — | $14 | 0.02% |
| CLARENCE E J CROUSE3 | 1110 EAST MORTON AVENUE JACKSONVILLE, IL 62650 | AFLAC | $13 | — | $13 | 0.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JOSEPH A WILLIS | 865 TROY OFALLON ROAD TROY, IL 62294 | AFLAC | $12 | — | $12 | 0.01% |
| PRESTON E LASH3 | 19711 CREEKSHORE DRIVE KATY, TX 77449 | AFLAC | $6 | — | $6 | 0.01% |
| ROXANNE C MYERS3 | 5905 SOUTH CANTRALL CREEK ROAD CANTRALL, IL 62625 | STANDARD INSURANCE COMPANY | $7K | — | $7K | 9.13% |
| ROXANNE C MYERS3 | 5905 SOUTH CANTRALL CREEK ROAD CANTRALL, IL 62625 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 8.00% |
| ROXANNE C MYERS3 | 5905 SOUTH CANTRALL CREEK ROAD CANTRALL, IL 62625 | STANDARD INSURANCE COMPANY | $1K | — | $1K | 11.00% |
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 | 200 | 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) | 200 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH ALLIANCE MEDICAL PLANS | 191 | $1.9M |
| Dental | STANDARD INSURANCE COMPANY | 163 | $80K |
| Life insurance | STANDARD INSURANCE COMPANY | 196 | $10K |
| Short-term disability | STANDARD INSURANCE COMPANY | 196 | $22K |
| Other(2 contracts, 2 carriers) | AFLAC | 196 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 196 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.