| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT A BROCK3 Filed as: ROBERT A. BROCK | PO BOX 17 FORSYTHE, IL 62535 | HUMANA INSURANCE COMPANY | $6K | $0 | $6K | 3.81% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP, INC. | 5110 NORTH 40TH STREET, SUITE 234 PHOENIX, AZ 85018 | HUMANA INSURANCE COMPANY | $0 | $141 | $141 | 0.10% |
| JARED JASON3 | 310 SO FIRST STREET, SUITE 102 CHAMPAIGN, IL 61820 | KANSAS CITY LIFE INSURANCE COMPANY | $10K | $0 | $10K | 9.40% |
| ROBERT A BROCK3 Filed as: ROBERT A. BROCK | 306 SOUTH SMITH FORSYTHE, IL 62535 | CONTINENTAL AMERICAN INSURANCE COMPANY | $375 | $0 | $375 | 3.68% |
| KEITH MCELYEA3 Filed as: KEITH J. MCELYEA | 512 SPITLER PLAZA MOUNT ZION, IL 62549 | CONTINENTAL AMERICAN INSURANCE COMPANY | $200 | $0 | $200 | 1.96% |
| GEORGE P OWENS3 Filed as: GEORGE P. OWENS | 653 ANTLER DRIVE MOUNT ZION, IL 62549 | CONTINENTAL AMERICAN INSURANCE COMPANY | $115 | $0 | $115 | 1.13% |
| SHARYL K BATHE3 Filed as: SHARYL K. BATHE | 1816 BROADWAY AVENUE MATTOON, IL 61938 | CONTINENTAL AMERICAN INSURANCE COMPANY | $81 | $0 | $81 | 0.80% |
| MJ INSURANCE3 Filed as: TERRY J. SILVERS AND VARIOUS AGENTS | 120 WEST ALLEN STREET HENDERSONVILLE, NC 28792 | CONTINENTAL AMERICAN INSURANCE COMPANY | $70 | $0 | $70 | 0.69% |
| DEVIN M PEGRAM3 Filed as: DEVIN M. PEGRAM | 1450 LENHART ROAD SPRINGFIELD, IL 62711 | CONTINENTAL AMERICAN INSURANCE COMPANY | $45 | $0 | $45 | 0.44% |
| JASON HOFFARD3 Filed as: JASON T. HOFFARD | 16485 BANISTER ROAD SESSER, IL 62884 | CONTINENTAL AMERICAN INSURANCE COMPANY | $34 | $0 | $34 | 0.33% |
| ROBERT A BROCK3 Filed as: ROBERT A. BROCK | PO BOX 17 FORSYTHE, IL 62535 | AFLAC | $170 | $0 | $170 | 5.96% |
| MARK L RHODES3 Filed as: MARK L. RHODES AND OTHER AGENTS | 1513 WEST COLUMBIA TERRACE APARTMENT 2 PEORIA, IL 61606 | AFLAC | $105 | $0 | $105 | 3.68% |
| JUNE D BROCK3 Filed as: JUNE D. BROCK | 306 SOUTH SMITH STREET FORSYTH, IL 62535 | AFLAC | $50 | $0 | $50 | 1.75% |
| TARA M JORDAN3 Filed as: TARA M. JORDAN | 800 LAKESHORE DRIVE TUSCOLA, IL 61953 | AFLAC | $27 | $0 | $27 | 0.95% |
| DAVID M CRUMLEY3 Filed as: DAVID M. CRUMLEY | 132 SEDONA WOODS TRAIL NOLENSVILLE, TN 37135 | AFLAC | $21 | $0 | $21 | 0.74% |
| JUDITH HAEFLINGER3 | 1275 SAXONY CIRCLE, UNIT 3205 PUNTA GORDA, FL 33983 | AFLAC | $21 | $0 | $21 | 0.74% |
| TIMOTHY J REED3 Filed as: TIMOTHY S. INGRAM | 1731 MOUNT ZION ROAD JACKSONVILLE, IL 62650 | AFLAC | $17 | $0 | $17 | 0.60% |
| USI INSURANCE SERVICES LLC3 | 312 ELM STREET, 24TH FLOOR CINCINNATI, OH 45202 | HARTFORD LIFE AND ACCIDENT | $112 | $38 | $150 | 20.00% |
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 | 169 | 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) | 169 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH ALLIANCE MEDICAL PLANS | 463 | $2.1M |
| Dental | HUMANA INSURANCE COMPANY | 155 | $147K |
| Vision | HUMANA INSURANCE COMPANY | 155 | $147K |
| Life insurance | KANSAS CITY LIFE INSURANCE COMPANY | 169 | $109K |
| Long-term disability | KANSAS CITY LIFE INSURANCE COMPANY | 169 | $109K |
| Prescription drug | HEALTH ALLIANCE MEDICAL PLANS | 463 | $2.1M |
| Other(4 contracts, 4 carriers) | KANSAS CITY LIFE INSURANCE COMPANY | 169 | $123K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 463 | — |
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.