| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HYLANT GROUP INC3 | 811 MADISON AVE 8TH FLOOR TOLEDO, OH 43604 | PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA | $42K | $0 | $42K | 2.73% |
| HYLANT GROUP INC3 | 6714 POINTE INVERNESS WAY STE 100 FORT WAYNE, IN 46804 | PRINCIPAL LIFE INSURANCE COMPANY | $9K | $0 | $9K | 7.81% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43604 | PRINCIPAL LIFE INSURANCE COMPANY | $666 | $0 | $666 | 0.60% |
| EUGENE BLACKMON3 | 5702 EVARD ROAD FORT WAYNE, IN 468350000 | AFLAC | $8K | $373 | $8K | 7.89% |
| DONALD E SPRINGER3 Filed as: DONALD E. SPRINGER | 220 INSURANCE DR SUITE A FORT WAYNE, IN 46845 | AFLAC | $6K | $377 | $6K | 5.89% |
| JEFFREY S HINES3 | 6225 SUGAR TREE PL FORT WAYNE, IN 46835 | AFLAC | $4K | $142 | $4K | 3.98% |
| MICHELLE L SEXTON3 | 220 INSURANCE DR. STE. A FORT WAYNE, IN 46825 | AFLAC | $3K | $247 | $4K | 3.46% |
| DAVID R KREMER3 | 2150 ASSOCIATION DR STE. 150 OKEMOS, MI 48864 | AFLAC | $2K | $249 | $2K | 2.36% |
| NICHOLAS DEAN SHIPE3 | 139 W LAKE LANSING RD STE 200 EAST LANSING, MI 48823 | AFLAC | $2K | $200 | $2K | 2.10% |
| JANICE STANSKI3 | 4001 HIGHWOOD DR. FORT WAYNE, IN 46815 | AFLAC | $1K | $0 | $1K | 1.11% |
| JUSTIN E FINTON3 Filed as: JUSTIN E. FINTON | 220 INSURANCE DR. SUITE A FORT WAYNE, IN 46825 | AFLAC | $860 | $49 | $909 | 0.88% |
| SUE E. JOHNSON3 Filed as: SUE E JOHNSON | PO BOX 155 WOLF LAKE, IN 46796 | AFLAC | $608 | $0 | $608 | 0.59% |
| IMELDA YOUNGBERG3 | 5176 BELLA COLLIMA ST. OCEANSIDE, CA 92056 | AFLAC | $473 | $0 | $473 | 0.46% |
| JERRY W MACHAMER3 | 1405 CURDES AVENUE FORT WAYNE, IN 46805 | AFLAC | $203 | $0 | $203 | 0.20% |
| CHARLES L GRAY3 | 105 DAVENTRY LANE SUITE 100 LOUISVILLE, KY 40223 | AFLAC | $180 | $0 | $180 | 0.18% |
| HAROLD/HUGHES INSURANCE3 | 3775 NORTH US 52 LEBANON, IN 46052 | AFLAC | $157 | $0 | $157 | 0.15% |
| JEREMY JAY JOHNSON3 Filed as: JEREMY J. JOHNSON | 7263 BRAXTON DRIVE NOBLESVILLE, IN 46062 | AFLAC | $123 | $0 | $123 | 0.12% |
| DIANN KRZCIOK3 | 2682 GRAND FORKS RD HENDERSON, NV 89052 | AFLAC | $55 | $0 | $55 | 0.05% |
| DOUGLAS FOX3 | 735 S GARFIELD AVE SUITE 203 TRAVERSE CITY, MI 49686 | AFLAC | $49 | $0 | $49 | 0.05% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN GLAUB | 54369 30TH ST SOUTH BEND, IN 46635 | AFLAC | $46 | $0 | $46 | 0.04% |
| KEITH MAURICE CASTILLO3 | 15813 NORTH 110TH AVE SUN CITY, AZ 85351 | AFLAC | $42 | $0 | $42 | 0.04% |
| NAVILLE & ASSOCIATES3 | 14220 OVERBROOK DR CARMEL, IN 46074 | AFLAC | $38 | $0 | $38 | 0.04% |
| MARSHA HUGHES3 | 3775 N STATE ROAD 52 LEBANON, IN 46052 | AFLAC | $36 | $0 | $36 | 0.04% |
| CARL MCKELLAR3 | 5530 CROSS POND SAN ANTONIO, TX 78249 | AFLAC | $24 | $0 | $24 | 0.02% |
| JOHN H. THOMPSON3 | 4602 NEWAYGO RD FORT WAYNE, IN 46808 | AFLAC | $22 | $0 | $22 | 0.02% |
| VITO DOMINIC PALUMBO3 | 17214 AMSTUTZ RD LEO, IN 46765 | AFLAC | $21 | $0 | $21 | 0.02% |
| BRADLEY K HARRISON3 Filed as: BRADLEY K. HARRISON | 3432 W TRUMAN BLVD JEFFERSON CITY, MO 65109 | AFLAC | $19 | $0 | $19 | 0.02% |
| JOHN W COURT3 Filed as: JOHN W. COURT | 11206 SHALIMER DRIVE FORT WAYNE, IN 46845 | AFLAC | $5 | $0 | $5 | 0.00% |
| NORMAN E. JOHNSON, TO THE ESTATE OF3 Filed as: NORMAN E. JOHNSON - THE ESTATE OF | 1984 S. SUGAR GUM TRL. GREENFIELD, IN 46140 | AFLAC | $4 | $0 | $4 | 0.00% |
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 | 240 | 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) | 240 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 288 | $111K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 288 | $111K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 288 | $111K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 288 | $111K |
| Other | AFLAC | 113 | $103K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 288 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.