| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 | 571 MONON BOULEVARD, SUITE 400 CARMEL, IN 46032 | HARTFORD LIFE AND ACCIDENT | $38K | $9K | $47K | 11.36% |
| WATCHTOWER BENEFITS, LLC3 | 227 WEST MONROE STREET, SUITE 5200 CHICAGO, IL 60606 | HARTFORD LIFE AND ACCIDENT | $0 | $6K | $6K | 1.39% |
| MJ INSURANCE3 | 571 MONON BOULEVARD, SUITE 400 CARMEL, IN 46032 | DELTA DENTAL OF INDIANA | $36K | $0 | $36K | 10.98% |
| SUSAN MARIE BARD3 | 7219 DERSTAIN ROAD INDIANAPOLIS, IN 46250 | AFLAC | $1K | $37 | $2K | 4.64% |
| DIANE MARIE FAH3 Filed as: DIANE MARIE WELCH AND OTHER AGENTS | 545 NORTH 8TH STREET RIVER FALLS, WI 54022 | AFLAC | $576 | $0 | $576 | 1.75% |
| BRIANNA LYNN ROWE3 | 3386 CHALICE COURT PLAINFIELD, IN 46168 | AFLAC | $534 | $0 | $534 | 1.62% |
| TAD HOWARD ASP3 | 10890 NORTH SMITH ROAD HAYWARD, WI 64843 | AFLAC | $290 | $0 | $290 | 0.88% |
| HOLLY RENEE ASHLEY3 | 720 SOUTH RIDGELINE ROAD APARTMENT 419 CARMEL, IN 46032 | AFLAC | $184 | $3 | $187 | 0.57% |
| PETER ROHOW3 | 1023 SUGAR PINE LANE NEW RICHMOND, WI 54017 | AFLAC | $161 | $0 | $161 | 0.49% |
| MARIA N VONDIELINGEN3 Filed as: MARIA N. VONDIELINGEN | 9912 RIDGE DRIVE INDIANAPOLIS, IN 46256 | AFLAC | $114 | $3 | $117 | 0.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: EQUITY RISK PARTNERS INSURANCE SVCS | 90 NEW MONTGOMERY, SUITE 250 SAN FRANCISCO, CA 94105 | FEDERAL INSURANCE COMPANY | $225 | $31 | $256 | 17.07% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY AND ASSOC. INS. GROUP, INC. | 1 KELLY WAY SPARKS, MD 21152 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $89 | $0 | $89 | 6.58% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $21 | $0 | $21 | 1.55% |
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 | 447 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 449 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF INDIANA | 737 | $324K |
| Vision | VISION SERVICE PLAN | 373 | $71K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 417 | $412K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 417 | $412K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 417 | $412K |
| Other(4 contracts, 4 carriers) | HARTFORD LIFE AND ACCIDENT | 447 | $447K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 737 | — |
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.