| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEVEN J. SNYDER3 Filed as: STEVEN T DUM | 1050 EAST 86TH STREET #55-C INDIANAPOLIS, IN 46240 | FIDELITY SECURITY LIFE INSURANCE CO. | $26K | — | $26K | 10.00% |
| KEY BENEFIT ADMINISTRATORS, INC5 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | FIDELITY SECURITY LIFE INSURANCE CO. | $13K | — | $13K | 5.00% |
| KEY BENEFIT ADMINISTRATORS, INC5 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | NATION UNION FIRE INSURANCE COMPANY OF PITTSBURG | $2K | — | $2K | 6.00% |
| STEVEN J. SNYDER3 Filed as: STEVEN T DUM | 8610 EAST 106TH STREET STE 200 FISHERS, IN 46037 | NATION UNION FIRE INSURANCE COMPANY OF PITTSBURG | $1K | — | $1K | 4.00% |
| STEVEN J. SNYDER3 Filed as: STEVEN T DUM | 1050 EAST 86TH STREET #55-C INDIANAPOLIS, IN 46250 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $759 | — | $759 | 10.00% |
| KEY BENEFIT ADMINISTRATORS, INC5 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $380 | — | $380 | 5.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS, INC EIN 35-1450364 NONE | Contract Administrator Service code 13 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | $56K |
| GREAT WEST HEALTHCARE/CIGNA EIN 84-0467907 NONE | Contract Administrator Service code 13 | P.O. BOX 64543 CINCINNATI, OH 45264 | $15K |
| STEVEN DUN NONE | Insurance agents and brokers Service code 22 | 1050 EAST 86TH STREET #55-C INDIANAPOLIS, IN 46240 | $8K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 NONE | Contract Administrator Service code 13 | 8330 ALLISON POINTE TRAIL INDIANAPOLIS, IN 46250 | $7K |
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 | 114 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | FIDELITY SECURITY LIFE INSURANCE CO. | 115 | $260K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 119 | $8K |
| Other(2 contracts, 2 carriers) | NATION UNION FIRE INSURANCE COMPANY OF PITTSBURG | 119 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 119 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.