| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RAUL MENDEZ3 | 19523 CAMINO RDG SAN ANTONIO, TX 78213 | AIG | $2K | — | $2K | — |
| RONALD KIRBY3 | 311 SW WATER ST 210 PEORIA, IL 61602 | AIG | $1K | — | $1K | — |
| CHRISTOPHER LUBBERS3 | 1603 CRAWFORD AVE PARSONS, KS 673573244 | AIG | $189 | — | $189 | — |
| CHRIS LOYD3 | PO BOX 4070 BARTLESVILLE, OK 740064070 | AIG | $167 | — | $167 | — |
| THOMAS CENTORBI3 | 820 S MAIN STREET - 208 SAINT CHARLES, MO 63301 | AIG | $126 | — | $126 | — |
| RANDALL OBRIEN3 | 4341 ACER GROVE DR STE 300C SPRINGFIELD, IL 627116343 | AIG | $84 | — | $84 | — |
| MERLE JONES3 | 575 MARSHALL DR SAINT ROBERT, MO 65584 | AIG | $52 | — | $52 | — |
| JEFF ROLCZYNSKI3 | 1985 DEKALB AVE SYCAMORE, IL 60178 | AIG | $41 | — | $41 | — |
| RICHARD SCHLEICHER3 | 6800 PARK TEN BLVD STE 130E SAN ANTONIO, TX 78213 | AIG | $20 | — | $20 | — |
| REAGAN WAGNER3 | 6800 PARK TEN BLVD STE 130E SAN ANTONIO, TX 78213 | AIG | $19 | — | $19 | — |
| TOUCHSTONE MCDONALD3 | 6800 PARK TEN STE 130E SAN ANTONIO, TX 78213 | AIG | $19 | — | $19 | — |
| STEPHEN MONGIE3 | 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 | $1K | — | $1K | — |
| MICHAEL R BERGERON3 | 2975 W EXECUTIVE PARKWAY STE 320 LEHI, UT 84043 | BENEFICIAL | $1K | — | $1K | — |
| MICHAEL P. OMALLEY3 | 8535 E HARTFORD DRIVE SUITE 108 SCOTTSDALE, AZ 85255 | COLUMBUS LIFE | $189 | — | $189 | — |
| INVESTMENT PLANNERS INC.3 | 226 W ELDORADO DECATUR, IL 62522 | COLUMBUS LIFE | $81 | — | $81 | — |
| LEWIS M. KELLEY, JR.3 | 37417 N TOM DARLINGTON DR STE 2 PO BOX 3470 CAREFREE, AZ 85377 | COLUMBUS LIFE | $47 | — | $47 | — |
| BENJAMIN WILLIAMS3 | 501 S TOWANDA BARNES RD BLOOMINGTON, IL 61704 | PENN MUTUAL | $315 | — | $315 | — |
| MARK DELGUERCIO3 | 501 S TOWANDA BARNES RD BLOOMINGTON, IL 61704 | PENN MUTUAL | $281 | — | $281 | — |
| BRADLEY TERRY3 | 226 W ELDORADO DECATUR, IL 62522 | PENN MUTUAL | $255 | — | $255 | — |
| JAMES PASSARELLI3 | 501 S TOWANDA BARNES RD BLOOMINGTON, IL 61704 | PENN MUTUAL | $155 | — | $155 | — |
| NICOLE WATSON3 | 501 TOWANDA BARNES ROAD BLOOMINGTON, IL 61705 | PENN MUTUAL | $66 | — | $66 | — |
| INVESTMENT PLANNERS INC.3 | 226 W ELDORADO DECATUR, IL 62522 | RELISTAR LIFE INSURANCE COMPANY | $160 | — | $160 | — |
| NICOLE WATSON3 Filed as: NICOLE F. WATSON | 501 TOWANDA BARNES ROAD BLOOMINGTON, IL 617054031 | NATIONAL LIFE OF VERMONT | $75K | — | $75K | — |
| GRACE T. BARNARD3 | PRESTON PARK FINANCIAL CENTER-WEST 4975 PRESTON PARK BLVD RECEPTION PLANO, TX 75093 | NATIONAL LIFE OF VERMONT | $31K | — | $31K | — |
| FIRST FINANCIAL MKTG SVCS3 | 442 W KENNEDY BLVD STE 312 TAMPA, FL 336061495 | NATIONAL LIFE OF VERMONT | $30K | — | $30K | — |
| NEW INVESTOR WORLD INC.3 | PRESTON PARK FINANCIAL CENTER-WEST 4975 PRESTON PARK BLVD RECEPTION PLANO, TX 75093 | NATIONAL LIFE OF VERMONT | $8K | — | $8K | — |
| STEVAN H. GATES3 | 6955 S UNION PARK CENTER SUITE 410 MIDVALE, UT 840476573 | NATIONAL LIFE OF VERMONT | $4K | — | $4K | — |
| JOEL E. GUTHMANN3 | 575 DONOFRIO MADISON, WI 53719 | NATIONAL LIFE OF VERMONT | $3K | — | $3K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LEGACY BENEFIT PLANS EIN 80-0113411 CONTRACT ADMINISTRATOR | Plan Administrator Service code 14 | 501 TOWANDA BARNES ROAD BLOOMINGTON, IL 61705 | $639K |
| DUGGAN BERTSCH, LLC EIN 26-3963060 NONE | Legal Service code 29 | 303 W MADISON SUITE 1000 CHICAGO, IL 60606 | $126K |
| 1800 MD EIN 27-1532190 NONE | Other services Service code 49 | 6408 BANNINGTON RD CHARLOTTE, NC 28226 | $48K |
| CLIFTON LARSON & ALLEN EIN 41-0746749 NONE | Accounting (including auditing) Service code 10 | 301 SW ADAMS ST 1000 PEORIA, IL 61602 | $22K |
| BUSINESS INTELLIGENCE ASSOCIATES EIN 75-3128219 NONE | Accounting (including auditing) Service code 10 | 950 TRADE CENTER WAY SUITE 240 PORTAGE, MI 490020493 | $9K |
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 | 788 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 788 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(8 contracts, 8 carriers) | AIG | 26 | $0 |
| Other | RELISTAR LIFE INSURANCE COMPANY | 1 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 26 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.