| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TCU AGENCY LLC3 | P. O. BOX 374 MISHAWAKA, IN 46546 | UNUM LIFE INSURANCE CO. OF AMERICA | $4K | — | $4K | 5.39% |
| TCU AGENCY LLC3 | PO BOX 374 MISHAWAKA, IN 46546 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 5.90% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DR., UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $195 | $2K | 4.37% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $140 | $2K | 4.27% |
| JENNON M CARUTH3 Filed as: JENNON M. CARUTH | 7825 WASHINGTON AVE S, SUITE 710 BLOOMINGTON, MN 55439 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 3.10% |
| TCU AGENCY LLC3 | P. O. BOX 374 MISHAWAKA, IN 46546 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | — | $6K | 22.30% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $377 | $5K | 18.12% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $279 | $5K | 17.76% |
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 | 687 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 687 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(3 contracts, 3 carriers) | UNUM LIFE INSURANCE CO. OF AMERICA | 649 | $157K |
| Other | UNUM LIFE INSURANCE CO. OF AMERICA | 649 | $75K |
| 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.