| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 600 HIGHWAY 169 S FL 18 ATTN TREASURY DEPARTMENT SAINT LOUIS PARK, MN 554261205 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $27 | $4K | 3.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SERVICES USA INC | 1018 W 9TH AVE KING OF PRUSSIA, PA 194061225 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | 1.93% |
| DOUGLAS L LAZ3 Filed as: DOUGLAS LAZ | 2107 S NEIL ST CHAMPAIGN, IL 61820 | THE KANSAS CITY LIFE INSURANCE COMPANY | $8K | — | $8K | 10.90% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | PO BOX 203991 DALLAS, TX 753203991 | VISION SERVICE PLAN | $933 | — | $933 | 6.16% |
| ROBERT BROCK3 | PO BOX 17 FORSYTH, IL 62535 | AFLAC | $315 | — | $315 | 3.02% |
| JUNE D BROCK3 | 306 S SMITH ST FORSYTH, IL 62535 | AFLAC | $135 | — | $135 | 1.29% |
| TERRANCE BRENNAN3 | 2106 E TAYLOR ST BLOOMINGTON, IL 61701 | AFLAC | $114 | — | $114 | 1.09% |
| MARK L RHODES3 | 133A SOUTH MAIN ST MORTON, IL 61550 | AFLAC | $113 | — | $113 | 1.08% |
| DAVID M CRUMLEY3 | 5111 MARYLAND WAY STE 210 BRENTWOOD, TN 37027 | AFLAC | $105 | — | $105 | 1.01% |
| STEPHEN L BLUST3 | 1114 E OAKLAND AVE BOX 1561 BLOOMINGTON, IL 61701 | AFLAC | $96 | — | $96 | 0.92% |
| HANA M MUELLER3 | PO BOX 283 STANFORD, IL 61774 | AFLAC | $43 | — | $43 | 0.41% |
| GEORGE P OWENS3 | 653 ANTLER DRIVE MT ZION, IL 62549 | AFLAC | $41 | — | $41 | 0.39% |
| GARY W WARE JR3 | 2306 VALLEYBROOK DR CHAMPAIGN, IL 61822 | AFLAC | $38 | — | $38 | 0.36% |
| CHRISTINE L BREWSTER3 | 2025 MAINE ST QUINCY, IL 62301 | AFLAC | $34 | — | $34 | 0.33% |
| JUDITH HAEFLINGER3 | 16135 MALBEC ST FISHERS, IN 46037 | AFLAC | $21 | — | $21 | 0.20% |
| CHRISTOPHER A SKEETERS3 | 808 N BRUNS LN SPRINGFIELD, IL 62702 | AFLAC | $14 | — | $14 | 0.13% |
| TERRY J SILVERS3 | 100 GREENLEAF DR FLAT ROCK, NC 28731 | AFLAC | $12 | — | $12 | 0.11% |
| HEATHER HEIL3 | 53 BROOKSIDE DR APT D CLIFTON, NJ 07012 | AFLAC | $12 | — | $12 | 0.11% |
| ANDY BILISOLY3 | 719 E IREDELL AVE MOORESVILLE, NC 28115 | AFLAC | $11 | — | $11 | 0.11% |
| ROY TRIMBLE3 | 810 S JOHANSON RD PEORIA, IL 61607 | AFLAC | $10 | — | $10 | 0.10% |
| ELIZABETH BILISOLY3 | 1405 WRAY RD STONEVILLE, NC 27048 | AFLAC | $8 | — | $8 | 0.08% |
| TYE ELLIOTT3 | 1300 N INDEPENDENCE CT GERMANTOWN HILLS, IL 61548 | AFLAC | $5 | — | $5 | 0.05% |
| ELIZABETH M GASPAROVIC3 | 1531 W RUE JAMES PL PALATINE, IL 60067 | AFLAC | $3 | — | $3 | 0.03% |
| ROBERT A BROCK3 | 306 SOUTH SMITH FORSYTH, IL 62535 | CONTINENTAL AMERICAN INSURANCE COMPANY | $659 | — | $659 | 6.44% |
| GEORGE P OWENS3 | 653 ANTLER DRIVE MT ZION, IL 62549 | CONTINENTAL AMERICAN INSURANCE COMPANY | $220 | — | $220 | 2.15% |
| SHARYL K BATHE3 | 620 ODD FELLOW RD MATTOON, IL 61938 | CONTINENTAL AMERICAN INSURANCE COMPANY | $166 | — | $166 | 1.62% |
| KEITH MCELYEA3 | 512 SPITLER PARK PLZ MT. ZION, IL 62549 | CONTINENTAL AMERICAN INSURANCE COMPANY | $118 | — | $118 | 1.15% |
| JASON HOFFARD3 Filed as: JASON T HOFFARD | 402 N MAIN ST BENTON, IL 62812 | CONTINENTAL AMERICAN INSURANCE COMPANY | $57 | — | $57 | 0.56% |
| TERRY J SILVERS3 | 120 W ALLEN STREET HENDERSONVILLE, NC 28792 | CONTINENTAL AMERICAN INSURANCE COMPANY | $50 | — | $50 | 0.49% |
| TAMMY KILGORE3 Filed as: TAMMY L KILGORE | 210 N PLUM ST PONTIAC, IL 61764 | CONTINENTAL AMERICAN INSURANCE COMPANY | $15 | — | $15 | 0.15% |
| TRAVIS COCKBURN3 | 402 N MAIN STREET BENTON, IL 62812 | CONTINENTAL AMERICAN INSURANCE COMPANY | $15 | — | $15 | 0.15% |
| TRAVIS COCKBURN3 | 402 N MAIN STREET BENTON, IL 62812 | CONTINENTAL AMERICAN INSURANCE COMPANY | $14 | — | $14 | 0.14% |
| MARTHA MONCKTON3 | 2411 E GRANDVIEW AVE PEORIA, IL 61614 | CONTINENTAL AMERICAN INSURANCE COMPANY | $11 | — | $11 | 0.11% |
| JASON HOFFARD3 Filed as: JASON T HOFFARD | 402 N MAIN BENTON, IL 62812 | CONTINENTAL AMERICAN INSURANCE COMPANY | $10 | — | $10 | 0.10% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | PO BOX 4016 CHAMPAIGN, IL 61824 | HARTFORD LIFE AND ACCIDENT | $113 | — | $113 | 15.07% |
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 | 161 | 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) | 161 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH ALLIANCE MEDICAL PLANS | 365 | $1.6M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 341 | $124K |
| Vision | VISION SERVICE PLAN | 122 | $15K |
| Life insurance | THE KANSAS CITY LIFE INSURANCE COMPANY | 161 | $74K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 161 | $750 |
| Long-term disability | THE KANSAS CITY LIFE INSURANCE COMPANY | 161 | $74K |
| Prescription drug | HEALTH ALLIANCE MEDICAL PLANS | 365 | $1.6M |
| Other(3 contracts, 3 carriers) | THE KANSAS CITY LIFE INSURANCE COMPANY | 161 | $95K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 365 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
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.