| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PLATINUM BENEFIT CONSULTING GROUP3 | 4215 EDISON LAKES PARKWAY STE 200 MISHAWAKA, IN 46545 | ANTHEM INSURANCE COMPANIES, INC. | $16K | $231 | $16K | 2.81% |
| INDIANA CHAMBER INSURANCE AGENCY3 | 115 WEST WASHINGTON ST SUITE 850S INDIANAPOLIS, IN 46204 | ANTHEM INSURANCE COMPANIES, INC. | $523 | — | $523 | 0.09% |
| PLATINUM BENEFIT CONSULTING GROUP3 | 4215 EDISON LAKES PARKWAY STE 200 MISHAWAKA, IN 46545 | ANTHEM INSURANCE COMPANIES, INC. | $7K | $91 | $7K | 2.84% |
| INDIANA CHAMBER INSURANCE AGENCY3 | 115 WEST WASHINGTON ST SUITE 850S INDIANAPOLIS, IN 46204 | ANTHEM INSURANCE COMPANIES, INC. | $212 | — | $212 | 0.09% |
| PLATINUM BENEFIT CONSULTING GROUP3 | 4215 EDISON LAKES PKWY STE 200 MISHAWAKA, IN 46545 | HARTFORD LIFE AND ACCIDENT | $8K | — | $8K | 15.00% |
| PLATINUM BENEFIT CONSULTING GROUP3 | 4215 EDISON LAKES PKWY SUITE 200 MISHAWAKA, IN 46545 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $796 | $3K | 7.30% |
| HORIZON PLANNING GROUP3 | 9000 KEYSTONE CROSS INDIANAPOLIS, IN 46240 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $27 | — | $27 | 0.06% |
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 | 111 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 25 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 137 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | ANTHEM INSURANCE COMPANIES, INC. | 22 | $797K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 76 | $48K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 76 | $48K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 111 | $55K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 111 | $55K |
| Other | HARTFORD LIFE AND ACCIDENT | 111 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 111 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.