| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 | 571 MONON BOULEVARD, SUITE 400 CARMEL, IL 46032 | HARTFORD LIFE AND ACCIDENT | $41K | $11K | $52K | 13.80% |
| WATCHTOWER BENEFITS, LLC3 | 227 WEST MONROE STREET, SUITE 5200 CHICAGO, IL 60606 | HARTFORD LIFE AND ACCIDENT | $0 | $6K | $6K | 1.50% |
| MJ INSURANCE3 | 571 MONON BOULEVARD, SUITE 400 CARMEL, IN 46032 | DELTA DENTAL OF INDIANA | $32K | $0 | $32K | 9.18% |
| SUSAN MARIE BARD3 | 7219 DERSTAN ROAD INDIANAPOLIS, IN 46250 | AFLAC | $2K | $131 | $2K | 5.33% |
| BRIANNA LYNN ROWE3 | 3386 CHALICE COURT PLAINFIELD, IN 46168 | AFLAC | $634 | $0 | $634 | 1.67% |
| MJ INSURANCE3 Filed as: DAVID W. SCOTT AND VARIOUS AGENTS | 131 EAST EXCHANGE AVENUE, SUITE 128 FORT WORTH, TX 76164 | AFLAC | $549 | $12 | $561 | 1.48% |
| TAD HOWARD ASP3 | 10890 NORTH SMITH ROAD HAYWARD, WI 54843 | AFLAC | $314 | $12 | $326 | 0.86% |
| HOLLY RENEE ASHLEY3 | 720 SOUTH RANGELINE ROAD APARTMENT 419 CARMEL, IN 46032 | AFLAC | $192 | $30 | $222 | 0.58% |
| DIANE MARIE FAH3 | 1119 BROADWAY STREET RIVER FALLS, WI 54022 | AFLAC | $153 | $17 | $170 | 0.45% |
| MARIA N VONDIELINGEN3 Filed as: MARIA N. VONDIELINGEN | 9912 RIDGE DRIVE INDIANAPOLIS, IN 46256 | AFLAC | $113 | $22 | $135 | 0.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: EQUITY RISK PARTNERS INS. SERVICES | 580 CALIFORNIA STREET, SUITE 1300 SAN FRANCISCO, CA 94101 | FEDERAL INSURANCE COMPANY | $225 | $33 | $258 | 17.20% |
| GETTYSBURG BNFTS ADMIN INC3 Filed as: GETTYSBURG BENEFITS ADMIN., INC. | PO BOX 1060 GETTYSBURG, PA 17325 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $82 | $0 | $82 | 6.57% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $19 | $0 | $19 | 1.52% |
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 | 455 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 456 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF INDIANA | 748 | $349K |
| Vision | VISION SERVICE PLAN | 373 | $71K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 405 | $379K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 405 | $379K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 405 | $379K |
| Other(4 contracts, 4 carriers) | HARTFORD LIFE AND ACCIDENT | 455 | $420K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 748 | — |
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.