| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HYLANT GROUP INC3 | — | PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA INC | $15K | — | $15K | 1.06% |
| SULLIVAN PATRICK S3 | SUITE 100 6714 POINTE INVERNESS WAY FORT WAYNE, IN 46804 | KANSAS CITY LIFE INSURANCE COMPANY | $3K | — | $3K | 5.00% |
| GRAY KENNETH W3 | 3110 MEADOWS PARK WA FORT WAYNE, IN 46825 | KANSAS CITY LIFE INSURANCE COMPANY | $3K | — | $3K | 5.00% |
| HYLANT GROUP INC3 Filed as: HYLANT OF INDIANA LLC | 6714 POINT INVERNESS WAY STE 100 FORT WAYNE, IN 46804 | PRO-CLAIM PLUS INC | — | $370 | $370 | 5.62% |
| KENNETH N GRAY3 | 3110 MEADOWS PARK WAY FORT WAYNE, IN 46825 | PRO-CLAIM PLUS INC | — | $362 | $362 | 5.50% |
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 | 130 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA INC | 186 | $1.4M |
| Dental | PRO-CLAIM PLUS INC | 123 | $7K |
| Life insurance | KANSAS CITY LIFE INSURANCE COMPANY | 130 | $50K |
| Long-term disability | KANSAS CITY LIFE INSURANCE COMPANY | 130 | $50K |
| Other | KANSAS CITY LIFE INSURANCE COMPANY | 130 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 186 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.