| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJ INSURANCE, INC. | 9225 PRIORTY WAY WEST DRIVE SUITE 100 INDIANAPOLIS, IN 46240 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $96K | — | $96K | 10.50% |
| ASSUREX3 Filed as: ASSUREX AGENCY INC. | 175 SOUTH THIRD STREET SUITE 800 COLUMBUS, OH 43215 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 0.62% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 50435 INDIANAPOLIS, IN 46250 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $21K | — | $21K | 10.00% |
| AMWINS5 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | STONEBRIDGE LIFE INSURANCE COMPANY | $12K | — | $12K | 6.67% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 9225 PRIORITY WAY WEST DRIVE SUITE 100 INDIANAPOLIS, IN 46240 | STONEBRIDGE LIFE INSURANCE COMPANY | $8K | — | $8K | 4.44% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 9225 PRIORITY WAY WEST DRIVE SUITE 100 INDIANAPOLIS, IN 46240 | TRANSAMERICA INSURANCE COMPANY | $11K | — | $11K | 8.25% |
| AMWINS5 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | TRANSAMERICA INSURANCE COMPANY | $11K | — | $11K | 8.19% |
| WEB TPA5 | 8500 FREEPORT PKWY SOUTH IRVING, TX 75063 | TRANSAMERICA INSURANCE COMPANY | $7K | — | $7K | 5.51% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 50435 INDIANAPOLIS, IN 46250 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 6.96% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 50435 INDIANAPOLIS, IN 46250 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
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 | 839 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 849 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TRANSAMERICA INSURANCE COMPANY | 71 | $135K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 825 | $914K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 825 | $914K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 790 | $209K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 839 | $90K |
| Prescription drug | STONEBRIDGE LIFE INSURANCE COMPANY | 71 | $176K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 790 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 839 | — |
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.