| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 3430 CARMEL, IN 46082 | ANTHEM INSURANCE COMPANIES, INC. | $27K | — | $27K | 3.66% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 3750 PRIORITY WAY SOUTH DRIVE INDIANAPOLIS, IN 46240 | ANTHEM INSURANCE COMPANIES, INC. | — | $5K | $5K | 0.68% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 9225 PRIORITY WAY WEST DRIVE SUITE 100 INDIANAPOLIS, IN 462401467 | HUMANADENTAL INSURANCE COMPANY | $5K | — | $5K | 10.80% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | P.O. BOX 3430 CARMEL, IN 460823430 | UNITEDHEALTHCARE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | 9225 PRIORITY WAY WEST DRIVE SUITE 100 INDIANAPOLIS, IN 46240 | ANTHEM LIFE INSURANCE COMPANY | $509 | — | $509 | 10.00% |
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 | 150 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 150 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 148 | $735K |
| Dental | HUMANADENTAL INSURANCE COMPANY | 139 | $46K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 82 | $12K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 150 | $5K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 150 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 150 | — |
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.