| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 9225 PRIORITY WAY WEST DR., STE 100 INDIANAPOLIS, IN 46240 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $299K | — | $299K | 12.05% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 9225 PRIORITY WAY WEST DR., STE 100 INDIANAPOLIS, IN 46240 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $73K | — | $73K | 2.95% |
| DG3 NORTH AMERICA INC5 Filed as: DG3 NORTH AMERICA INC. | 100 BURMA ROAD JERSEY CITY, NJ 07305 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $13K | $13K | 0.54% |
| ASSUREDPARTNERS3 Filed as: THE HDH GROUP INC. | 210 6TH AVE., 30TH FLOOR PITTSBURGH, PA 15222 | HIGHMARK INC. | $58K | — | $58K | 3.23% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 8880 RIO SAN DIEGO DR., STE 790 SAN DIEGO, CA 921081682 | KAISER FOUNDATION HEALTH PLAN INC. | $18K | — | $18K | 5.27% |
| MCKELVEY, PHILIP, NEILL3 | 600 W LOVELAND AVE., SUITE 5A LOVELAND, OH 45140 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | — | $6K | 1.94% |
| M J INSURANCE INC.3 Filed as: M-J INSURANCE INC. | P. O. BOX 50435 INDIANAPOLIS, IN 46250 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 1.36% |
| RONALD F REMAK INSURANCE INC3 Filed as: RONALD F REMAK INSURANCE INC. | 306 STATE ROAD 446 BLOOMINGTON, IN 47401 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $764 | — | $764 | 0.24% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $331 | $55 | $386 | 0.12% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS. SVCS USA, INC. | P. O. BOX 601478 CHARLOTTE, NC 28260 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $118 | — | $118 | 0.04% |
| ERNEST FALCO3 | 350 CROWN OAK CENTRE DRIVE LONGWOOD, FL 32750 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $111 | — | $111 | 0.03% |
| BULLOCK, KATHERINE, WATTS3 | 1308 SILVERPOINT ROAD CHAPIN, SC 29036 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.00% |
| FISHER, MARY, ELIZABETH3 | 8644 DE LOSS DRIVE RIVERSIDE, CA 92508 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 8880 RIO SAN DIEGO DR., STE 790 SAN DIEGO, CA 921081682 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 7.41% |
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 | 8,469 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 8,469 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HIGHMARK INC. | 207 | $2.1M |
| Dental(2 contracts, 2 carriers) | UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY | 194 | $88K |
| Vision(2 contracts, 2 carriers) | HIGHMARK INC. | 207 | $1.8M |
| Life insurance(3 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 8,556 | $4.1M |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 5,222 | $2.5M |
| Long-term disability(2 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 8,556 | $3.8M |
| Prescription drug | HIGHMARK INC. | 207 | $1.8M |
| Other(3 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 8,556 | $4.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,556 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.