| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS, INC3 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46226 | ZURICH AMERICAN INSURANCE COMPANY | $10K | — | $10K | 2.30% |
| SIMPLICITY LIFE INC.5 Filed as: SIMPLICITY LIFE INC | 4134 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46226 | ZURICH AMERICAN INSURANCE COMPANY | $10K | — | $10K | 2.29% |
| INTERGRITY BENEFIT PARTNERS, INC3 | 9511 ANGOLA CT STE 263 INDIANAPOLIS, IN 46268 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $15K | — | $15K | 16.42% |
| LYDIA C CLARK3 Filed as: LYDIA CLARK | 11882 PINE MEADOW CIR FISHERS, IN 46037 | DELTA DENTAL OF OHIO | $1K | — | $1K | 2.26% |
| INTERGRITY BENEFIT PARTNERS, INC3 | 9511 ANGOLA CT STE 263 INDIANAPOLIS, IN 46268 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 19.16% |
| INTERGRITY BENEFIT PARTNERS, INC4 | 9511 ANGOLA CT STE 263 INDIANAPOLIS, IN 46268 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 15.46% |
| KEY BENEFIT ADMINISTRATORS, INC3 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46226 | QBE INSURANCE CORPORATION | $1K | — | $1K | 6.00% |
| INTERGRITY BENEFIT PARTNERS, INC5 | 11925 E 65TH ST STE 5 INDIANAPOLIS, IN 46236 | QBE INSURANCE CORPORATION | $981 | — | $981 | 4.00% |
| INTERGRITY BENEFIT PARTNERS, INC3 | 11882 PINE MEADOW CIR FISHERS, IN 46037 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | — | $1K | 6.52% |
| INTERGRITY BENEFIT PARTNERS, INC3 | 11925 E 65TH ST STE 5 INDIANAPOLIS, IN 46236 | STANDARD INSURANCE COMPANY | $104 | — | $104 | 15.23% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS, INC EIN 35-1450364 NOT RELATED | Claims processing; Insurance brokerage commissions and fees; Other services; Contract Administrator; Insurance agents and brokers; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 8330 ASSISON POINTE TRAIL INDIANAPOLIS, IN 46250 | $158K |
| GREATWEST HEALTHCARE/CIGNA EIN 84-0467907 NOT RELATED | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing Service code 12 | PO BOX 182223 CHATTANOOGA, TN 374227223 | $44K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 NOT RELATED | Claims processing; Contract Administrator Service code 12 | 8330 ASSISON POINTE TRAIL INDIANAPOLIS, IN 46250 | $23K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ZURICH AMERICAN INSURANCE COMPANY | 0 | $420K |
| Dental | DELTA DENTAL OF OHIO | 284 | $64K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $20K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 436 | $41K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $91K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $42K |
| Other | QBE INSURANCE CORPORATION | 0 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 436 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.