| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 571 MONON BOULEVARD, SUITE 400 CARMEL, IN 46032 | DELTA DENTAL OF INDIANA | $31K | $554 | $32K | 9.98% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | PO BOX 3430 CARMEL, IN 46082 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $24K | $9K | $33K | 13.59% |
| SUSAN MARIE BARD3 | 7219 DERSTAN ROAD INDIANAPOLIS, IN 46250 | AFLAC | $3K | $130 | $3K | 6.31% |
| TAD HOWARD ASP3 | 10890 NORTH SMITH ROAD HAYWARD, WI 54843 | AFLAC | $3K | $125 | $3K | 5.03% |
| BRIANNA LYNN ROWE3 | 3386 CHALICE COURT PLAINFIELD, IN 46168 | AFLAC | $1K | $0 | $1K | 2.29% |
| MJ INSURANCE3 Filed as: MICHAEL PEDERSON AND VARIOUS AGENTS | 101 NORTH FARWELL STREET SUITE 203 EAU CLAIRE, WI 54703 | AFLAC | $880 | $26 | $906 | 1.70% |
| DAVID W SCOTT3 Filed as: DAVID W. SCOTT | 131 EAST EXCHANGE AVENUE, SUITE 128 FORT WORTH, TX 76164 | AFLAC | $382 | $0 | $382 | 0.72% |
| BENJAMIN HUNTER3 | 18401 AVEBURY LANE WESTFIELD, IN 46062 | AFLAC | $186 | $19 | $205 | 0.38% |
| VICKIE SUE MASTERS3 | 14012 THEODORA LANE ALEDO, TX 76008 | AFLAC | $145 | $0 | $145 | 0.27% |
| GETTYSBURG BENEFITS ADMINISTRATORS3 | PO BOX 1060 GETTYSBURG, PA 17325 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $228 | $0 | $228 | 6.77% |
| CBIZ BENEFITS & INSURANCE SERVICES | PO BOX 632886 CINCINNATI, OH 45263 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $90 | $0 | $90 | 2.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: EQUITY RISK PARTNERS INS. SERVICES | 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 | 405 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 410 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF INDIANA | 692 | $317K |
| Vision | VISION SERVICE PLAN | 350 | $67K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 405 | $244K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 405 | $244K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 405 | $244K |
| Other(4 contracts, 4 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 405 | $302K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 692 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.