| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJ INSURANCE, INC. | 9225 PRIORITY WAY WEST DRIVE SUITE 100 INDIANAPOLIS, IN 46240 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $39K | — | $39K | 8.00% |
| ASSUREX3 Filed as: ASSUREX AGENCY INC. | 175 SOUTH THIRD STREET SUITE 800 COLUMBUS, OH 43215 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $194 | $9K | $10K | 1.98% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 50435 INDIANAPOLIS, IN 462500435 | HARTFORD LIFE AND ACCIDENT | $58K | $5K | $63K | 18.50% |
| MCKELVEY, PHILIP, NEILL3 | 600 WEST LOVELAND AVENUE SUITE 5A LOVELAND, OH 45140 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.73% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS GLAROS | 200 MONTICELLO P.O. BOX 184 DYER, IN 46311 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $310 | — | $310 | 1.04% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 50435 INDIANAPOLIS, IN 46250 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $278 | — | $278 | 0.93% |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 459 | $484K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 459 | $484K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 649 | $339K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 649 | $339K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 649 | $339K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 649 | $369K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 649 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.