| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FRANK WAINSCOTT3 | 1100 BOULDERS PKWY STE 600 NORTH CHESTERFIELD, VA 232254060 | AIG | $4K | — | $4K | — |
| RONALD KIRBY3 | 311 SW WATER ST 210 PEORIA, IL 61602 | AIG | $4K | — | $4K | — |
| MICHAEL GRAMM3 | 217 HIGHWAY 40 W WILLMAR, MN 562012707 | AIG | $3K | — | $3K | — |
| TREVOR SUTTERFIELD3 | 501 E 4TH ST BARTLESVILLE, OK 740033906 | AIG | $2K | — | $2K | — |
| RAUL MENDEZ3 | 11503 NW MILITARY HWY 201 SAN ANTONIO, TX 78231 | AIG | $2K | — | $2K | — |
| JAMES HINTZ3 | 14130 CHARTER LANDING CT MIDLOTHIAN, VA 231144682 | AIG | $1K | — | $1K | — |
| CRAIG NELSON3 | 1230 E 1350 N AMERICAN FORK, UT 84003 | AIG | $301 | — | $301 | — |
| CHRISTOPHER LUBBERS3 | 1603 CRAWFORD AVE PARSONS, KS 673573244 | AIG | $177 | — | $177 | — |
| THOMAS CENTORBI3 | 2958 WESTERLAND DR SAINT CHARLES, MO 63301 | AIG | $174 | — | $174 | — |
| CHRIS LOYD3 | PO BOX 4070 BARTLESVILLE, OK 740064070 | AIG | $123 | — | $123 | — |
| RANDALL OBRIEN3 | 4341 ACER GROVE DR STE 300C SPRINGFIELD, IL 627116343 | AIG | $75 | — | $75 | — |
| MERLE JONES3 | 575 MARSHALL DR SAINT ROBERT, MO 65584 | AIG | $75 | — | $75 | — |
| MEREDITH DEKKER3 | 1490 S PRICE RD 103 CHANDLER, AZ 85286 | AIG | $66 | — | $66 | — |
| JEFF ROLCZYNSKI3 | 1985 DEKALB AVE SYCAMORE, IL 60178 | AIG | $40 | — | $40 | — |
| RICHARD SCHLEICHER3 | 6800 PARK TEN BLVD STE 130E SAN ANTONIO, TX 78213 | AIG | $39 | — | $39 | — |
| REAGAN WAGNER3 | 6800 PARK TEN BLVD STE 130E SAN ANTONIO, TX 78213 | AIG | $37 | — | $37 | — |
| TOUCHSTONE MCDONALD3 | 6800 PARK TEN STE 130E SAN ANTONIO, TX 78213 | AIG | $37 | — | $37 | — |
| STEPHEN MONGIE4 | 3000 N UNIVERSITY AVE 350 PROVO, UT 84604 | BENEFICIAL | $5K | — | $5K | — |
| ARNETT INSURANCE SERVICES LLC3 Filed as: ARNETT INSURANCE SERVICE | 3850 E BASELINE ROAD 106 MESA, AZ 85206 | BENEFICIAL | $4K | — | $4K | — |
| MICHAEL R BERGERON3 | 2975 W EXECUTIVE PARKWAY STE 320 LEHI, UT 84043 | BENEFICIAL | $1K | — | $1K | — |
| MICHAEL P. OMALLEY3 | 8535 E HARTFORD DR STE 108 SCOTTSDALE, AZ 85255 | COLUMBUS LIFE | $306 | — | $306 | — |
| INVESTMENT PLANNERS INC.3 | 226 W ELDORADO ST DECATUR, IL 62522 | COLUMBUS LIFE | $131 | — | $131 | — |
| LEWIS M. KELLEY, JR.3 Filed as: LEWIS MILTON KELLEY, JR | 37417 N TOM DARLINGTON DR STE 2 CAREFREE, AZ 85377 | COLUMBUS LIFE | $54 | — | $54 | — |
| PURSHE KAPLAN STERLING INVES3 | 18 CORPORATE WOODS BLVD ALBANY, NY 12211 | JACKSON NATIONAL | $532 | — | $532 | — |
| BENJAMIN WILLIAMS3 | 501 S TOWANDA BARNES RD BLOOMINGTON, IL 61704 | PENN MUTUAL | $472 | — | $472 | — |
| MARK DELGUERCIO3 | 501 S TOWANDA BARNES RD BLOOMINGTON, IL 61704 | PENN MUTUAL | $421 | — | $421 | — |
| BRADLEY TERRY3 | 226 W ELDORADO DECATUR, IL 62522 | PENN MUTUAL | $383 | — | $383 | — |
| JAMES PASSARELLI3 | 501 S TOWANDA BARNES RD BLOOMINGTON, IL 61704 | PENN MUTUAL | $154 | — | $154 | — |
| NICOLE WATSON3 | 501 TOWANDA BARNES ROAD BLOOMINGTON, IL 61705 | PENN MUTUAL | $66 | — | $66 | — |
| KEITH KILMA3 | 501 S TOWANDA BARNES RD BLOOMINGTON, IL 61704 | PENN MUTUAL | — | — | $0 | — |
| RANDALL OBRIEN3 | 4341 ACER GROVE DR STE 300C SPRINGFIELD, IL 62711 | PENN MUTUAL | — | — | $0 | — |
| JOEL GUTHMANN3 | 501 S TOWANDA BARNES RD BLOOMINGTON, IL 61704 | PENN MUTUAL | — | — | $0 | — |
| PAUL FUNKHOUSER3 | 501 TOWANDA BARNES ROAD BLOOMINGTON, IL 61705 | PENN MUTUAL | — | — | $0 | — |
| PURSHE KAPLAN STERLING INVESTMENTS | 18 CORPORATE WOODS BLVD ALBANY, NY 12211 | TRANSAMERICA | $167 | — | $167 | — |
| NANM LLC3 | 8400 E PRENTICE AVE STE 1250 GREENWOOD VILLAGE, CO 80111 | TRANSAMERICA | $12 | — | $12 | — |
| REBECCA MCKEEN3 | 501 S TOWANDA BARNES RD BLOOMINGTON, IL 61704 | TRANSAMERICA | $10 | — | $10 | — |
| MICHAEL WAYNE NEWTON3 | 501 S TOWANDA BARNES RD BLOOMINGTON, IL 61704 | RELISTAR LIFE INSURANCE COMPANY | — | — | $0 | — |
| STEVEN PRUIETT3 | 501 TOWANDA BARNES ROAD BLOOMINGTON, IL 61705 | RELISTAR LIFE INSURANCE COMPANY | — | — | $0 | — |
| ARNETT INSURANCE SERVICES LLC3 Filed as: ARNETT INSURANCE SERV | 3850 E BASELINE RD SUITE 106 MESA, AZ 85206 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | — | — | $0 | — |
| INSIGHT BENEFITS GROUP LLC3 | 501A S TOWANDA BARNES ROAD SUITE 3 BLOOMINGTON, IL 61705 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | — | — | $0 | — |
| GALILEE BROKERS INTERNATIONAL LLC3 | PO BOX 5044 PEORIA, AZ 85385 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | — | — | $0 | — |
| MICHAEL J. WOOLLEY3 | 96 S 100 E AMERICAN FORK, UT 84003 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | — | — | $0 | — |
| SPENCER HALL3 | 627 E REDONDO AVE SALT LAKE CITY, UT 84105 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DUGGAN BERTSCH, LLC EIN 26-3963060 NONE | Legal Service code 29 | 303 W MADISON SUITE 1000 CHICAGO, IL 60606 | $268K |
| GDAF, LLP EIN 20-3355912 NONE | Legal Service code 29 | 1 E WACKER DRIVE STE 1700 CHICAGO, IL 606011814 | $193K |
| IBG BENEFITS MANAGEMENT COMPANY INC EIN 66-0757514 PARTY-IN-INTEREST | Consulting (general) Service code 16 | 100 NORTH POINT CENTER EAST SUITE 310 ALPHARETTA, GA 30022 | $163K |
| MUTUAL BANK EIN 39-2004336 TRUSTEE | Trustee (bank, trust company, or similar financial institution) Service code 21 | 1701 S TOWANDA AVENUE BLOOMINGTON, IL 61701 | $65K |
| BARNES & THORNBURG, LLP EIN 35-0900596 NONE | Legal Service code 29 | 11 SOUTH MERIDIAN ST INDIANAPOLIS, IN 462043535 | $24K |
| 1800 MD EIN 27-1532190 NONE | Other services Service code 49 | 6408 BANNINGTON RD CHARLOTTE, NC 28226 | $21K |
| CLIFTON LARSON & ALLEN EIN 41-0746749 NONE | Accounting (including auditing) Service code 10 | — | $19K |
| CHARLES SCHWAB EIN 94-1737782 NONE | Custodial (securities) Service code 19 | 211 MAIN STREET SAN FRANCISCO, CA 94105 | $8K |
| SPECIAL COUNSEL EIN 52-1736703 NONE | Consulting (general) Service code 16 | DEPT CH 14305 PALATINE, IL 60055 | $7K |
| GRABRIAN ACTUARIAL EIN 47-1928849 NONE | Actuarial Service code 11 | 3660 WESTON LANE N PLYMOUTH, MN 55446 | $6K |
| COME TO BUY, INC. EIN 37-1395322 NONE | Other services Service code 49 | 3006 GILL STREET E BLOOMINGTON, IL 61704 | $0 |
| IBG ADMINISTRATIVE SERVICES LLC EIN 80-0113406 SUPPORT SERVICES | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 501 S TOWANDA BARNES ROAD BLOOMINGTON, IL 617054047 | $0 |
| LEGACY BENEFIT PLANS EIN 80-0113411 CONTRACT ADMINISTRATOR | Plan Administrator Service code 14 | 501 TOWANDA BARNES ROAD BLOOMINGTON, IL 61705 | $0 |
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 | 493 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Beneficiaries receiving benefits | 1 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 500 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(7 contracts, 7 carriers) | AIG | 38 | $0 |
| Other(2 contracts, 2 carriers) | RELISTAR LIFE INSURANCE COMPANY | 1 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 38 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.