Form 5500 · Employee benefit plan · NORMAL, IL
OBRIEN AUTOMOTIVE TEAM INC
The filing calls this plan O'BRIEN AUTOMOTIVE GROUP PREMIUM CONVERSION PLAN.
OBRIEN AUTOMOTIVE TEAM INC of NORMAL, IL spreads its employee benefits across 4 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is CLEMENS & ASSOCIATES LIFE AGENCY. Coverage is written through BLUECROSS BLUESHIELD OF ILLINOIS and 3 other carriers. The plan's most recent policy period ended in January.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 01-0631714 · plan 501 · plan year 2024, filed Aug 28, 2025
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: death benefits.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 4 insured contracts covering health, dental, vision, life and disability; the largest, with BLUECROSS BLUESHIELD OF ILLINOIS, covers 264 people.
Reported premium across the insured contracts is $1,543,220, with $89,225 in disclosed broker commissions — about 5.8% of premium.
The health contract's policy period ended in January, while at least one ancillary line's policy period ended in December. The plan is on a split renewal cycle.
CLEMENS & ASSOCIATES LIFE AGENCY is the broker of record on 2 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including BLUECROSS BLUESHIELD OF ILLINOIS, SUN LIFE ASSURANCE COMPANY OF CANADA, DEARBORN LIFE INSURANCE COMPANY and FIDELITY SECURITY LIFE INSURANCE COMPANY. BLUECROSS BLUESHIELD OF ILLINOIS writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUECROSS BLUESHIELD OF ILLINOIS | Health, Dental | 264 | Feb 1, 2024 | $1,369,312 | $62,212 |
| SUN LIFE ASSURANCE COMPANY OF CANADA | Disability | 53 | Jan 1, 2025 | $91,059 | $15,402 |
| DEARBORN LIFE INSURANCE COMPANY | Vision, Life | 407 | Feb 1, 2024 | $78,626 | $10,978 |
| FIDELITY SECURITY LIFE INSURANCE COMPANY | — | 1 | Jan 1, 2025 | $4,223 | $633 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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