| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 308 NORTH 21ST STREET ST. LOUIS, MO 63103 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $58K | $2K | $60K | 4.07% |
| JARED JASON3 | 310 SOUTH 1ST STREET, SUITE 102 CHAMPAIGN, IL 61820 | KANSAS CITY LIFE INSURANCE COMPANY | $8K | $0 | $8K | 10.03% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $939 | $0 | $939 | 6.47% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: DAVID KEENAN AND ASSOCIATES, INC. | UNKNOWN SAVOY, IL 61874 | ASSURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 14.88% |
| WARE GROUP GENERAL AGENCIES3 | UNKNOWN SAVOY, IL 61874 | ASSURITY LIFE INSURANCE COMPANY | $850 | $0 | $850 | 7.21% |
| MICHAEL PETERS & ASSOCIATES, INC.3 Filed as: MICHAEL PETERS AND ASSOCIATES, INC. | UNKNOWN SAVOY, IL 61874 | ASSURITY LIFE INSURANCE COMPANY | $232 | $0 | $232 | 1.97% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | $1K | $361 | $2K | 19.28% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: DAVID T. KEENAN | 3808 WEST SPRINGFIELD AVENUE SUITE C CHAMPAIGN, IL 61822 | TRANSAMERICA LIFE INSURANCE COMPANY | $58 | $0 | $58 | 1.47% |
| GARY WOOD ASSOCIATES, INC.3 Filed as: GARY WARE AND ASSOCIATES, INC. | 3808 WEST SPRINGFIELD AVENUE SUITE C CHAMPAIGN, IL 61822 | TRANSAMERICA LIFE INSURANCE COMPANY | $54 | $0 | $54 | 1.37% |
| USI INSURANCE SERVICES LLC3 | PO BOX 201503 DALLAS, TX 75320 | TRANSAMERICA LIFE INSURANCE COMPANY | $29 | $0 | $29 | 0.73% |
| MICHAEL L. SEBENS3 Filed as: MICHAEL PETERS | 3808 WEST SPRINGFIELD AVENUE SUITE C CHAMPAIGN, IL 61822 | TRANSAMERICA LIFE INSURANCE COMPANY | $28 | $0 | $28 | 0.71% |
| BENJAMIN J. MEYER3 | 706 SOUTH NILES TUSCOLA, IL 61953 | TRANSAMERICA LIFE INSURANCE COMPANY | $23 | $0 | $23 | 0.58% |
| USI INSURANCE SERVICES LLC3 | 2107 SOUTH NEIL STREET CHAMPAIGN, IL 61820 | TRANSAMERICA LIFE INSURANCE COMPANY | $5 | $0 | $5 | 0.13% |
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 | 109 | 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) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 229 | $1.5M |
| Dental | KANSAS CITY LIFE INSURANCE COMPANY | 109 | $76K |
| Vision | VISION SERVICE PLAN | 109 | $15K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 25 | $8K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ILLINOIS | 229 | $1.5M |
| Other(3 contracts, 3 carriers) | ASSURITY LIFE INSURANCE COMPANY | 39 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 229 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.