| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUNTINGTON INSURANCE INC3 | 440 POLARIS PKWY WESTERVILLE, OH 430826999 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | $11K | $17K | 9.06% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, INC. | 312 ELM ST., 24TH FL CINCINNATI, OH 45202 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | — | $4K | 1.86% |
| HUNTINGTON INSURANCE INC3 | 440 POLARIS PKWY WESTERVILLE, OH 43082 | PRINCIPAL LIFE INSURANCE COMPANY | $9K | $4K | $12K | 21.67% |
| MARCIA M. HUMMEL3 Filed as: MARCIA M HUMMEL | 51327 HOLLYHOCK RD SOUTH BEND, IN 46637 | AFLAC | $2K | — | $2K | 3.55% |
| KELLY G. WENTZ3 Filed as: KELLY G WENTZ | 9307 HAVENBROOKE WAY KNOXVILLE, TN 37922 | AFLAC | $1K | $263 | $2K | 3.46% |
| PAUL M MARTINDALE3 | 10255 PRETTY LAKE TRAIL PLYMOUTH, IN 46563 | AFLAC | $688 | $51 | $739 | 1.49% |
| ROBERT L. FOWLER3 Filed as: ROBERT L FOWLER | 5720 ARROYO DUNES AVE LAS VEGAS, NV 89130 | AFLAC | $516 | — | $516 | 1.04% |
| BENJAMIN HUNTER3 | 735 S GARFIELD AVE STE 203 TRAVERSE CITY, MI 49686 | AFLAC | $306 | — | $306 | 0.62% |
| DAVID R KREMER3 | 2150 ASSOCIATION DR., STE. 150 OKEMOS, MI 48864 | AFLAC | $226 | $53 | $279 | 0.56% |
| DANIEL L. BLACKETOR3 Filed as: DANIEL L BLACKETOR | 59701 MYRTLE RD SOUTH BEND, IN 46614 | AFLAC | $232 | — | $232 | 0.47% |
| NAVILLE & ASSOCIATES3 | 14220 OVERBROOK DR CARMEL, IN 46074 | AFLAC | $83 | $53 | $136 | 0.27% |
| JEFFREY SCOTT GIBSON3 | 14301 N. 87TH ST. STE. 313 SCOTTSDALE, AZ 85260 | AFLAC | $121 | — | $121 | 0.24% |
| GARY A MIDDLETON3 Filed as: GARY A. MIDDLETON | PO BOX 151 BRISTOL, IN 46507 | AFLAC | $100 | — | $100 | 0.20% |
| ELIZABETH ANN FIFFIE3 Filed as: ELIZABETH A COURTNEY | PO BOX 361534 MELBOURNE, FL 32936 | AFLAC | $94 | — | $94 | 0.19% |
| DOUGLAS E FOX3 | 735 S. GARFIELD AVE., STE. 230 TRAVERSE CITY, MI 49686 | AFLAC | $78 | — | $78 | 0.16% |
| JOHN F GLAUB3 | 54369 30TH ST SOUTH BEND, IN 46635 | AFLAC | $75 | — | $75 | 0.15% |
| CYNTHIA LERNER RUBIN3 Filed as: CYNTHIA J LANGER | 1901 ACORN DR SAINT JOSEPH, MI 49085 | AFLAC | $63 | — | $63 | 0.13% |
| MONICA WENTZ3 Filed as: MONICA G WENTZ | 9307 HAVENBROOKE WAY KNOXVILLE, TN 37922 | AFLAC | $58 | — | $58 | 0.12% |
| MATTHEW M NACHAZEL3 | 1001 N HICKORY RD., STE. 3 SOUTH BEND, IN 46615 | AFLAC | $45 | — | $45 | 0.09% |
| DOUGLAS P FRANCKOWSKI3 | 85 BRIGHTON PARK DR SAINT CHARLES, MO 63303 | AFLAC | $34 | — | $34 | 0.07% |
| JOHN W COURT3 | 11206 SHALIMAR DR FORT WAYNE, IN 46845 | AFLAC | $33 | — | $33 | 0.07% |
| MARY CARMELA BERARDI3 | 3617 BEATEN PATH LEXINGTON, KY 40509 | AFLAC | $32 | — | $32 | 0.06% |
| BRADLEY K HARRISON3 | 3432 W TRUMAN BLVD JEFFERSON CITY, MO 65109 | AFLAC | $27 | — | $27 | 0.05% |
| LIB WILSON & ASSOCIATES, INC.3 Filed as: LIB WILSON & ASSOCIATES, INC | 214 EDGEWOOD DRIVE NICHOLASVILLE, KY 40356 | AFLAC | $26 | — | $26 | 0.05% |
| D ELAINE PINKOWSKI3 | HC 64 BOX 1815 CASTLE VALLEY, UT 84532 | AFLAC | $25 | — | $25 | 0.05% |
| JACKIE R CLINDANIEL3 | 821 E WINDSOR AVE UNIT 2 ELKHART, IN 46514 | AFLAC | $20 | — | $20 | 0.04% |
| SEAN PATRICK LENNON3 | 2122 MADISON GROVE LN L KNOXVILLE, TN 37922 | AFLAC | $20 | — | $20 | 0.04% |
| MATTHEW M NACHAZEL3 | 3550 PARK PL. W., STE. 300 MISHAWAKA, IN 46545 | AFLAC | $19 | — | $19 | 0.04% |
| JOHN TYLER & ASSOCIATES3 | 130 DUCK HAWK WAY MARIETTA, SC 29661 | AFLAC | $17 | — | $17 | 0.03% |
| BERN MCGRANE3 | 24593 BELMAR DR ELKHART, IN 46517 | AFLAC | $16 | — | $16 | 0.03% |
| DENNIS A. RHOADS3 | PO BOX 1262 SOUTH BEND, IN 46624 | AFLAC | $16 | — | $16 | 0.03% |
| MICHAEL FATHERREE3 | PO BOX 36823 TUCSON, AZ 85740 | AFLAC | $15 | — | $15 | 0.03% |
| LISA E. CARLSON3 | 9927 SAPPHIRE BERRY LN FISHERS, IN 46038 | AFLAC | $9 | — | $9 | 0.02% |
| MICHAEL A. BLAIR3 | 212 KNOB HILL DR LOCUST GROVE, GA 30248 | AFLAC | $9 | — | $9 | 0.02% |
| PAULA GAIL NEAL3 Filed as: PAULA C CUTTER | 1795 ALYSHEBA WAY, STE. 1204 LEXINGTON, KY 40509 | AFLAC | $8 | — | $8 | 0.02% |
| BRENT L GOODE3 | 2000 GLEN ECHO RD, STE. 204 NASHVILLE, TN 37215 | AFLAC | $6 | — | $6 | 0.01% |
| CHARLES F PINKOWSKI3 Filed as: CHARLES F. PINKOWSKI | 53104 OAKTON DR SOUTH BEND, IN 46635 | AFLAC | $6 | — | $6 | 0.01% |
| RUEANN EMERSON3 | 4820 LAKE BROOK DR., STE. 125 SUITE 100 GLEN ALLEN, VA 23060 | AFLAC | $5 | — | $5 | 0.01% |
| HARROLD/HUGHES INSURANCE3 Filed as: HARROLD HUGHES INSURANCE | 3775 N US 52 LEBANON, IN 46052 | AFLAC | $4 | — | $4 | 0.01% |
| KELLY G. WENTZ3 Filed as: KELLY G WENTZ | 9307 HAVENBROOK WAY KNOXVILLE, TN 37922 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5K | — | $5K | 16.55% |
| PAUL M MARTINDALE3 | 10255 PRETTY CAKE TRAIL PLYMOUTH, IN 46563 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | 3.62% |
| DAVID J MCCLELLAN3 Filed as: DAVID KREMER | 3550 PARK PLACE W MISHAWAKA, IN 46545 | CONTINENTAL AMERICAN INSURANCE COMPANY | $597 | — | $597 | 1.89% |
| ERIN PEDERSON3 | 123 CENTER PARK DR., STE. 102 KNOXVILLE, TN 37922 | CONTINENTAL AMERICAN INSURANCE COMPANY | $424 | — | $424 | 1.34% |
| NAVILLE & ASSOCIATES3 Filed as: NAVILLE AND ASSOCIATES | 14220 OVERBROOK DRIVE CARMEL, IN 46074 | CONTINENTAL AMERICAN INSURANCE COMPANY | $411 | — | $411 | 1.30% |
| MATTHEW D BUTLER3 Filed as: MATTHEW D. BUTLER | 2427 COVERED BRIDGE BLVD. KNOXVILLE, TN 37932 | CONTINENTAL AMERICAN INSURANCE COMPANY | $269 | — | $269 | 0.85% |
| MARK A WOJDA3 Filed as: MARK WOJDA | 9247 N MERIDIAN ST STE 205 INDIANAPOLIS, IN 46260 | CONTINENTAL AMERICAN INSURANCE COMPANY | $46 | — | $46 | 0.15% |
| MATTHEW A COOK3 | 9247 N MERIDIAN ST STE 205 INDIANAPOLIS, IN 46260 | CONTINENTAL AMERICAN INSURANCE COMPANY | $46 | — | $46 | 0.15% |
| JOHN T CLANCY3 | 4025 PETE DYE BLVD CARMEL, IN 46033 | CONTINENTAL AMERICAN INSURANCE COMPANY | $37 | — | $37 | 0.12% |
| JAY S OLEARY3 Filed as: JAY S. O'LEARY | 301 MALLORY STATION RD., STE. 100 FRANKLIN, TN 37067 | CONTINENTAL AMERICAN INSURANCE COMPANY | $33 | — | $33 | 0.10% |
| JENNIFER L MITCHEN3 | 8344 THACKERY COURT INDIANAPOLIS, IN 46256 | CONTINENTAL AMERICAN INSURANCE COMPANY | $20 | — | $20 | 0.06% |
| ALAN W MARTIN3 Filed as: ALAN W. MARTIN | 12524 MALLARD BAY DRIVE KNOXVILLE, TN 37922 | CONTINENTAL AMERICAN INSURANCE COMPANY | $16 | — | $16 | 0.05% |
| KEVIN F WARD3 | 12632 DOUBLE EAGLE DR CARMEL, IN 46033 | CONTINENTAL AMERICAN INSURANCE COMPANY | $9 | — | $9 | 0.03% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, INC. | 312 ELM STREET, 24TH FL CINCINNATI, OH 45202 | ZURICH AMERICAN INSURANCE COMPANY | $419 | — | $419 | 8.68% |
| HUNTINGTON INSURANCE INC3 Filed as: HUNTINGTON INSURANCE INC. | 440 POLARIS PARKWAY, STE. 400 WESTERVILLE, OH 43082 | ZURICH AMERICAN INSURANCE COMPANY | $305 | — | $305 | 6.32% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 NONE | Other fees; Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $410K |
| HUNTINGTON INSURANCE INC NONE | Non-monetary compensation; Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 440 POLARIS PKWY WESTERVILLE, OH 43082 | $51K |
| USI MIDWEST, LLC EIN 31-0507943 NONE | Insurance brokerage commissions and fees; Other commissions; Insurance agents and brokers Service code 22 | — | $36K |
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 | 477 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 477 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 323 | $388K |
| Dental | COMMUNITY INSURANCE COMPANY | 323 | $388K |
| Vision | COMMUNITY INSURANCE COMPANY | 323 | $388K |
| Life insurance(2 contracts) | PRINCIPAL LIFE INSURANCE COMPANY | 477 | $249K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 477 | $192K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY | 323 | $388K |
| Other(3 contracts, 3 carriers) | AFLAC | 176 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 477 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.