| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT A BROCK3 | PO BOX 17 FORSYTH, IL 62535 | HUMANA INSURANCE COMPANY | $6K | $0 | $6K | 3.41% |
| JARED JASON3 | 2107 SOUTH NEIL STREET CHAMPAIGN, IL 61853 | KANSAS CITY LIFE INSURANCE | $11K | $0 | $11K | 10.16% |
| ROBERT A BROCK3 Filed as: ROBERT A. BROCK | 306 SOUTH SMITH FORSYTH, IL 62535 | CONTINENTAL AMERICAN INSURANCE COMPANY | $593 | $0 | $593 | 6.02% |
| KEITH MCELYEA3 Filed as: KEITH J. MCELYEA | 512 SPITLER PARK PLAZA MOUNT ZION, IL 62549 | CONTINENTAL AMERICAN INSURANCE COMPANY | $179 | $0 | $179 | 1.82% |
| GEORGE P OWENS3 Filed as: GEORGE P. OWENS | 653 ANTLER DRIVE MOUNT ZION, IL 62549 | CONTINENTAL AMERICAN INSURANCE COMPANY | $120 | $0 | $120 | 1.22% |
| MJ INSURANCE3 Filed as: TERRY SILVERS AND VARIOUS AGENTS | 120 WEST ALLEN STREET HENDERSONVILLE, NC 28792 | CONTINENTAL AMERICAN INSURANCE COMPANY | $87 | $0 | $87 | 0.88% |
| SHARYL K BATHE3 Filed as: SHARYL K. JUNEAU | 1816 BROADWAY AVENUE MATTOON, IL 61938 | CONTINENTAL AMERICAN INSURANCE COMPANY | $84 | $0 | $84 | 0.85% |
| DEVIN M PEGRAM3 Filed as: DEVIN M. PEGRAM | 1450 LENHART ROAD SPRINGFIELD, IL 62711 | CONTINENTAL AMERICAN INSURANCE COMPANY | $36 | $0 | $36 | 0.37% |
| JASON HOFFARD3 Filed as: JASON T. HOFFARD | 16485 BANNISTER ROAD SESSER, IL 62884 | CONTINENTAL AMERICAN INSURANCE COMPANY | $32 | $0 | $32 | 0.32% |
| MJ INSURANCE3 Filed as: GEORGE P. OWENS AND VARIOUS AGENTS | 653 NORTH ANTLER DRIVE MOUNT ZION, IL 62549 | AFLAC | $214 | $0 | $214 | 3.20% |
| ROBERT A BROCK3 Filed as: ROBERT A. BROCK | PO BOX 17 FORSYTH, IL 62535 | AFLAC | $197 | $0 | $197 | 2.95% |
| JUNE D BROCK3 Filed as: JUNE D. BROCK | 306 SOUTH SMITH FORSYTH, IL 62535 | AFLAC | $123 | $0 | $123 | 1.84% |
| MARK L RHODES3 Filed as: MARK L. RHODES | 133 SOUTH MAIN STREET, SUITE A MORTON, IL 61550 | AFLAC | $62 | $0 | $62 | 0.93% |
| DAVID M CRUMLEY3 Filed as: DAVID M. CRUMLEY | 5111 MARYLAND WAY, SUITE 210 BRENTWOOD, TN 37027 | AFLAC | $58 | $0 | $58 | 0.87% |
| TERRANCE M BRENNAN3 Filed as: TERRANCE M. BRENNAN | 605 NORTH PARK AVENUE CHATHAM, IL 62629 | AFLAC | $53 | $0 | $53 | 0.79% |
| STEPHEN L BLUST3 Filed as: STEPHEN L. BLUST | PO BOX 1561 BLOOMINGTON, IL 61701 | AFLAC | $52 | $0 | $52 | 0.78% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | PO BOX 4016 CHAMPAIGN, IL 61824 | HARTFORD LIFE AND ACCIDENT | $113 | $38 | $151 | 20.13% |
| USI INSURANCE SERVICES LLC3 | 470 PARK AVENUE, 6TH FLOOR NEW YORK, NY 10016 | HARTFORD LIFE AND ACCIDENT | $0 | $17 | $17 | 2.27% |
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 | 197 | 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) | 197 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH ALLIANCE MEDICAL PLAN | 399 | $2.2M |
| Dental | HUMANA INSURANCE COMPANY | 167 | $164K |
| Vision | HUMANA INSURANCE COMPANY | 167 | $164K |
| Life insurance | KANSAS CITY LIFE INSURANCE | 197 | $112K |
| Long-term disability | KANSAS CITY LIFE INSURANCE | 197 | $112K |
| Prescription drug | HEALTH ALLIANCE MEDICAL PLAN | 399 | $2.2M |
| Other(4 contracts, 4 carriers) | KANSAS CITY LIFE INSURANCE | 197 | $130K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 399 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
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.