| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 3430 CARMEL, IN 46082 | ANTHEM INSURANCE COMPANIES, INC. | $12K | — | $12K | 1.87% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 3750 PRIORITY WAY SOUTH DRIVE INDIANAPOLIS, IN 46240 | ANTHEM INSURANCE COMPANIES, INC. | $3K | $57 | $3K | 0.54% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 571 MONON BOULEVARD INDIANAPOLIS, IN 46032 | DELTA DENTAL OF INDIANA | $6K | — | $6K | 10.01% |
| MJ INSURANCE3 Filed as: MJ INSURANCE, INC. | 571 MONON BOULEVARD SUITE 400 CARMEL, IN 46032 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $126 | $3K | 14.55% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 3430 CARMEL, IN 46082 | ANTHEM LIFE INSURANCE COMPANY | $725 | — | $725 | 6.22% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 3750 PRIORITY WAY SOUTH DRIVE INDIANAPOLIS, IN 46240 | ANTHEM LIFE INSURANCE COMPANY | $264 | — | $264 | 2.27% |
| MJ INSURANCE3 Filed as: MJ INSURANCE, INC. | 571 MONON BOULEVARD SUITE 400 CARMEL, IN 46032 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $59 | $1K | 14.45% |
| PHILIP N. MCKELVEY3 Filed as: PHILIP N MCKELVEY | 3931 SOUTH DIXIE DRIVE DAYTON, OH 45439 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $424 | — | $424 | 8.78% |
| MJ INSURANCE3 Filed as: MJ INSURANCE, INC. | 571 MONON BOULEVARD SUITE 400 CARMEL, IN 46032 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $283 | $18 | $301 | 6.24% |
| ASSUREX3 | 175 SOUTH 3RD STREET SUITE 800 COLUMBUS, OH 43215 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $11 | $11 | 0.23% |
| PHILIP N. MCKELVEY3 Filed as: PHILIP N MCKELVEY | 3931 SOUTH DIXIE DRIVE DAYTON, OH 45439 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $261 | — | $261 | 9.01% |
| MJ INSURANCE3 Filed as: MJ INSURANCE, INC. | 571 MONON BOULEVARD SUITE 400 CARMEL, IN 46032 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $142 | $2 | $144 | 4.97% |
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 | 96 | 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) | 97 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 155 | $636K |
| Dental | DELTA DENTAL OF INDIANA | 156 | $58K |
| Vision | ANTHEM INSURANCE COMPANIES, INC. | 155 | $636K |
| Life insurance(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY | 89 | $20K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 96 | $18K |
| Other(4 contracts, 3 carriers) | ANTHEM LIFE INSURANCE COMPANY | 89 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 156 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.