| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: CONNOR & GALLAGHER BENEFITS SE | 4933 LINCOLN AVENUE LISLE, IL 60532 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $16K | $0 | $16K | 10.15% |
| COMPTON FINANCIAL CORPORATION3 | 100 SAWMILL ROAD SUITE 2300 LAFAYETTE, IN 47905 | TRANSAMERICA LIFE INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
| FRED J. SCOTT3 Filed as: THE FRED SCOTT GROUP INC | 8320 ALLISON POINTE BLVD CASTLETON, IN 462501696 | TRANSAMERICA LIFE INSURANCE COMPANY | $1 | $0 | $1 | 0.01% |
| THE SCOTT GROUP BENEFITS SPEC LLC3 | 8320 ALLISON POINTE BLVD INDIANAPOLIS, IN 46250 | AFLAC | $297 | $0 | $297 | 3.12% |
| RONALD R KELLENBERGER3 | 725 ROBINSWOOD LN METOMORA, IL 61548 | AFLAC | $98 | $0 | $98 | 1.03% |
| JOHN T CLANCY3 | 4025 PETE DYE BLVD CARMEL, IN 46033 | AFLAC | $98 | $0 | $98 | 1.03% |
| MARK A WOJDA3 | 16258 DOGWOOD LN PLYMOUTH, IN 46563 | AFLAC | $65 | $0 | $65 | 0.68% |
| BESSIE A GREEN3 | 20187 STATE ROAD 37 N NOBLESVILLE, IN 46060 | AFLAC | $52 | $0 | $52 | 0.55% |
| ELIZABETH L KERBER3 | 716 S 21ST ST LAFAYETTE, IN 47905 | AFLAC | $37 | $0 | $37 | 0.39% |
| JOHN D TYLER3 | 2131 KILEY WAY EDMOND, OK 73034 | AFLAC | $23 | $0 | $23 | 0.24% |
| RANDAL R YURCZYK3 | 6858 E 525 S WHITESTOWN, IN 46075 | AFLAC | $21 | $0 | $21 | 0.22% |
| DAILEY INC.3 Filed as: B JO DAILEY | 2728 VINEWOOD DR INDIANAPOLIS, IN 46224 | AFLAC | $20 | $0 | $20 | 0.21% |
| TYE ELLIOTT3 | 1300 N INDEPENDENCE CT GERMANTOWN HILLS, IL 61548 | AFLAC | $20 | $0 | $20 | 0.21% |
| KENNETH P BORDERS3 | 1308 W WAHALLA LN PHOENIX, AZ 85027 | AFLAC | $19 | $0 | $19 | 0.20% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INS AGCY INC | PO BOX 11177 SOUTH BEND, IN 46634 | AFLAC | $18 | $0 | $18 | 0.19% |
| DON C CALL JR3 | 5512 YOUNKIN DR INDIANAPOLIS, IN 46268 | AFLAC | $16 | $0 | $16 | 0.17% |
| L EDWARD LANTMAN3 | 201 W WILLOW KNOLLS DR STE 206 PEORIA, IL 61614 | AFLAC | $15 | $0 | $15 | 0.16% |
| RIGGS COUNSELMAN MICHAELS & DOWNES3 Filed as: RIGGS INSURANCE INC | 465 NORTHLAND AVE NE STE 201 CEDAR RAPIDS, IA 52402 | AFLAC | $13 | $0 | $13 | 0.14% |
| DONALD BYCROFT3 | 3500 KEYMEER DR APT 1 DUBUQUE, IA 52002 | AFLAC | $13 | $0 | $13 | 0.14% |
| CHARLES ROBERTS3 Filed as: CHARLES W ROBERTS | W17983 WOLFE RD GERMFASK, MA 49836 | AFLAC | $13 | $0 | $13 | 0.14% |
| MATTHEW D SMITH3 | 7905 TANCES DR CINCINNATO, OH 45243 | AFLAC | $12 | $0 | $12 | 0.13% |
| ROGER N HOLT3 | 2012 CLIBURN RD LAFAYETTE, IA 47909 | AFLAC | $11 | $0 | $11 | 0.12% |
| HARROLD/HUGHES INSURANCE3 | 3775 N STATE ROAD 52 LEBANON, IA 46052 | AFLAC | $11 | $0 | $11 | 0.12% |
| JANIE L THORNTON3 | 1209 ISLAMORADA BLVD PUNTA GORDA, FL 33955 | AFLAC | $9 | $0 | $9 | 0.09% |
| ELIZABETH M GASPAROVIC3 | 18 N SMITH ST PALATINE, IL 61607 | AFLAC | $8 | $0 | $8 | 0.08% |
| ROSEMARY TRIMBLE3 | 810 S JOHANSON RD PEORIA, IL 61607 | AFLAC | $8 | $0 | $8 | 0.08% |
| SCOTT A SMITH3 | 5300 OAKBROOK PKWY STE 300 STE 350 NORCROSS, GA 30093 | AFLAC | $7 | $0 | $7 | 0.07% |
| THOMAS J. ROSENGREN3 Filed as: THOMAS J ROSENGREN | 1417 W 20TH ST STERLING, IL 61081 | AFLAC | $7 | $0 | $7 | 0.07% |
| JOSHUA J PARISE3 | 7325 JANES AVE WOODRIDGE, IA 60517 | AFLAC | $7 | $0 | $7 | 0.07% |
| DON C CALL JR3 | 6248 ELLER CREEK DR FISHERS, IN 46038 | AFLAC | $5 | $0 | $5 | 0.05% |
| MICHAEL E MCCARTHY3 | PO BOX 1017 DUNDEE, IL 60118 | AFLAC | $5 | $0 | $5 | 0.05% |
| JAMES M FLETCHER3 | 7325 CLUBHOUSE DR FORT WAYNE, IN 46835 | AFLAC | $5 | $0 | $5 | 0.05% |
| KIMBERLY A BENESH3 | 711 FRANT ST WALKER, IA 52352 | AFLAC | $4 | $0 | $4 | 0.04% |
| ROY W WERNER3 | BOX 2437 WEST LAFAYETTE, IN 47906 | AFLAC | $3 | $0 | $3 | 0.03% |
| DENNIS J CASSENS3 | 4646 E MARRILL RD BYRON, IL 61010 | AFLAC | $3 | $0 | $3 | 0.03% |
| MICHAEL A ORTIZ3 | 4119 CORNFLOWER RD POPLAR GROVE, IL 61065 | AFLAC | $3 | $0 | $3 | 0.03% |
| KENNETH L RUSHTON3 | 883 S STATE ROAD 3 RUSHVILLE, IN 46173 | AFLAC | $3 | $0 | $3 | 0.03% |
| MATTHEW D BUTLER3 | 123 CENTER PARK DR STE 102 KNOXVILLE, TN 37922 | AFLAC | $2 | $0 | $2 | 0.02% |
| TODD DEVOSS3 Filed as: TODD C DEVOSS | 321 N CLARK ST STE 625 CHICAGO, IA 60654 | AFLAC | $2 | $0 | $2 | 0.02% |
| RAY ARTHUR WALL3 | 1901 S WEINBACH AVE EVANSVILLE, IA 47714 | AFLAC | $2 | $0 | $2 | 0.02% |
| KEVIN F WARD3 | 12632 DOUBLE EAGLE DR CARMEL, IN 46033 | AFLAC | $1 | $0 | $1 | 0.01% |
| MATTHEW A COOK3 | 10069 BENT TREE LN FISHERS, IN 46037 | AFLAC | $1 | $0 | $1 | 0.01% |
| JACQUELINE CASTRO3 Filed as: JACQUELINE S CASTRO | 131 E 39TH ST APT 3 NEW YORK, NY 10016 | AFLAC | $1 | $0 | $1 | 0.01% |
| GREGORY J SHARP3 | 702 E 5TH ST COAL VALLEY, IL 61240 | AFLAC | $1 | $0 | $1 | 0.01% |
| TOMMY M HICKS3 | 1416 WARREN PL LAFAYETTE, IA 47905 | AFLAC | $1 | $0 | $1 | 0.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: CONNOR & GALLAGHER INS SERVICE | 750 WARRENVILLE ROAD, SUITE 400 LISLE, IL 60532 | METROPOLITAN LIFE INSURANCE COMPANY | $652 | $2K | $2K | 11520.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $276K |
| CONNOR & GALLAGHER BENEFIT SERVICES EIN 04-3831656 BROKER | Other commissions Service code 55 | — | $80K |
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 | 267 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 268 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 205 | $36K |
| Life insurance(2 contracts, 2 carriers) | TRANSAMERICA LIFE INSURANCE COMPANY | 25 | $12K |
| Short-term disability | AFLAC | 25 | $10K |
| Long-term disability(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 317 | $158K |
| Stop-loss / reinsurancereinsurance | STEALTH PARTNER GROUP - QBE INS CORP | 270 | $329K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 317 | $158K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 317 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.