| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 571 MONON BOULEVARD CARMEL, IN 46032 | DELTA DENTAL OF INDIANA | $23K | — | $23K | 7.01% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 3430 CARMEL, IN 460823430 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $9K | $2K | $11K | 12.61% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 3430 CARMEL, IN 460823430 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $9K | $2K | $11K | 12.66% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 3430 CARMEL, IN 460823430 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $7K | $2K | $9K | 12.66% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 3430 CARMEL, IN 460823430 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | $1K | $6K | 12.64% |
| SUSAN MARIE BARD3 | 7219 DERSTAN ROAD INDIANAPOLIS, IN 46250 | AFLAC | $3K | $101 | $3K | 6.91% |
| TAD HOWARD ASP3 | 10890 NORTH SMITH ROAD HAYWARD, WI 54843 | AFLAC | $1K | — | $1K | 3.37% |
| BRIANNA LYNN ROWE3 | 3386 CHALICE COURT PLAINFIELD, IN 46168 | AFLAC | $1K | $20 | $1K | 2.90% |
| BENJAMIN HUNTER3 | 18401 AVEBURY LANE WESTFIELD, IN 46062 | AFLAC | $215 | $20 | $235 | 0.58% |
| CLARIBEL LUPE DELEON3 Filed as: CLARIBEL LUPE LOZA | 711 BLANDIN STREET SUITE 204 FORT WORTH, TX 76111 | AFLAC | $159 | — | $159 | 0.39% |
| DAVID W SCOTT3 | 131 EAST EXCHANGE AVENUE SUITE 128 FORT WORTH, TX 76164 | AFLAC | $104 | — | $104 | 0.26% |
| SAMANTHA J BREUER3 | 101 NORTH FARWELL STREET SUITE 203 EAU CLAIRE, WI 54703 | AFLAC | $102 | — | $102 | 0.25% |
| JOHN J HINDS3 | 12 HONEYSUCKLE LANE GOFFSTOWN, NH 03045 | AFLAC | $79 | — | $79 | 0.20% |
| SAMANTHA J BREUER3 | E4355 PINEWOOD CIRCLE ELEVA, WI 54738 | AFLAC | $66 | — | $66 | 0.16% |
| MARY L WILLIAMS3 | 1102 STEVENS STREET SUITE 1 BRIDGEPORT, TX 76426 | AFLAC | $44 | — | $44 | 0.11% |
| KEVIN DELANEY3 Filed as: KEVIN ANDREW DELANEY | 2 SWAN TER GREENLAND, NH 03840 | AFLAC | $43 | — | $43 | 0.11% |
| ASHLEY SHAW LLC3 | 2501 MADISON AVENUE INDIANAPOLIS, IN 46225 | AFLAC | $21 | — | $21 | 0.05% |
| CHARLES LAWSON3 Filed as: CHARLES GLEN LAWSON | 1919 EASTSIDE LAKE ROAD GRAHAM, TX 76450 | AFLAC | $20 | — | $20 | 0.05% |
| JONATHON E BURGESS3 | 434 DONALD STREET BEDFORD, NH 03110 | AFLAC | $20 | — | $20 | 0.05% |
| CYNTHIA LUQUIN3 | 2200 EAST ROUTE 66 SUITE 215 GLENDORA, CA 91740 | AFLAC | $10 | — | $10 | 0.02% |
| JOSEPH D. HUGHES3 Filed as: JOSEPH D HUGHES | 1347 HILLANDALE AVENUE UNIT D LA HABRA, CA 90631 | AFLAC | $7 | — | $7 | 0.02% |
| DAVID J REESOR3 | 2220 EAST ROUTE 66 SUITE 215 GLENDORA, CA 91740 | AFLAC | $5 | — | $5 | 0.01% |
| JOSEPH D. HUGHES3 Filed as: JOSEPH D HUGHES | 1809 ALTA STREET LA HABRA, CA 90631 | AFLAC | $5 | — | $5 | 0.01% |
| GETTYSBURG BENEFITS ADMINISTRATION3 | P.O. BOX 1060 GETTYSBURG, PA 17325 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $254 | — | $254 | 8.89% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | P.O. BOX 632886 CINCINNATI, OH 452632886 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $121 | — | $121 | 4.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: EQUITY RISK PARTNERS INSURANCE SVCS | 44 2ND STREET SAN FRANCISCO, CA 94105 | FEDERAL INSURANCE COMPANY | $225 | $32 | $257 | 17.13% |
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 | 413 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 417 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF INDIANA | 713 | $322K |
| Vision | VISION SERVICE PLAN | 363 | $66K |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 413 | $154K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 295 | $86K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 413 | $45K |
| Other(4 contracts, 4 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 413 | $113K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 713 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.