| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| 1ST SOURCE INSURANCE3 | JENNIFER ADDIS 6909 GRAPE RD MISHAWAKA, IN 46545 | PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA INC. | $28K | — | $28K | 2.93% |
| KENNETH R OLSON3 | THE HORTON GROUP INC 10320 ORLAND PKWY ORLAND PARK, IL 60467 | PARAMOUNT DENTAL, INC. | $6K | — | $6K | 10.00% |
| SHULTZ INSURANCE AGENCY INC3 | 340 COLUMBIA ST STE 200 SOUTH BEND, IN 46601 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $219 | $4K | 12.60% |
| 1ST SOURCE INSURANCE3 | 6909 GRAPE ROAD MISHAWAKA, IN 46545 | COMPANION LIFE INSURANCE COMPANY | $1K | — | $1K | 12.63% |
| PHYSICIANS HEALTH PLAN OF NORTHERN3 | INDIANA 1700 MAGNOVOX WAY STE 201 FORT WAYNE, IN 46804 | COMPANION LIFE INSURANCE COMPANY | $600 | — | $600 | 6.31% |
| SUMMIT REINSURANCE SERVICES INC3 Filed as: SUMMIT REINSURANCE SERVICES, INC. | 7030 POINTE INVERNESS WAY STE 350 FORT WAYNE, IN 46804 | COMPANION LIFE INSURANCE COMPANY | $190 | — | $190 | 2.00% |
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 | 135 | 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) | 135 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA INC. | 88 | $966K |
| Dental | PARAMOUNT DENTAL, INC. | 95 | $58K |
| Life insurance | COMPANION LIFE INSURANCE COMPANY | 131 | $10K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 118 | $29K |
| Prescription drug | PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA INC. | 88 | $966K |
| Other | COMPANION LIFE INSURANCE COMPANY | 131 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 131 | — |
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.