| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEYSTONE INSURANCE & BENEFITS GROUP3 | 13800 JACKSON RD MISHAWAKA, IN 465449195 | UNITEDHEALTHCARE INSURANCE COMPANY | $49K | — | $49K | 3.19% |
| THE BRAMAN AGENCY LLC3 Filed as: THE BRAMAN AGCY LLC | 8001 BROADWAY, STE 300 MERRILLVILLE, IN 464105551 | UNITEDHEALTHCARE INSURANCE COMPANY | $10K | — | $10K | 0.68% |
| KEYSTONE INSURANCE & BENEFITS GROUP3 | 13800 JACKSON ROAD MISHAWAKA, IN 46544 | ANTHEM INSURANCE COMPANIES, INC. | $20K | — | $20K | 2.28% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CLIFTONLARSONALLEN LLP EIN 41-0746749 N/A | Accounting (including auditing) Service code 10 | — | $19K |
| WELLS FARGO BANK, N.A. N/A | Trustee (bank, trust company, or similar financial institution) Service code 21 | 200 WOODLAND PRIME 1ST MENOMONEE FALLS, WI 53051 | $5K |
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 | 112 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 162 | $2.4M |
| Vision | ANTHEM INSURANCE COMPANIES, INC. | 141 | $872K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 162 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.