| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SOURCEONE GROUP LLC3 | — | AMERICAN UNITED LIFE INSURANCE COMPANY | $45K | — | $45K | 6.52% |
| SOURCEONE GROUP LLC3 | 6628 CONSTITUTION DR FORT WAYNE, IN 46804 | AFLAC | $7K | — | $7K | 4.21% |
| DONALD E SPRINGER3 Filed as: DONALD SPRINGER | 3670 SUN STONE WAY NEW HAVEN, IN 46774 | AFLAC | $2K | — | $2K | 1.30% |
| MOLLY KURTZ3 Filed as: MOLLY MARIE KURTZ | 1154 E 900 N OSSIAN, IN 46777 | AFLAC | $2K | $251 | $2K | 1.09% |
| ERIC BROGAN3 Filed as: ERIC SPENGEL | 103 N MAIN ST STE 3 CROWN POINT, IN 46307 | AFLAC | $895 | — | $895 | 0.54% |
| JONATHAN DAVID BESWARICK3 Filed as: JONATHAN BESWARICK | 220 INSURANCE DRIVE FORT WAYNE, IN 46825 | AFLAC | $661 | $149 | $810 | 0.49% |
| ROBERT J LAWRENCE3 Filed as: ROBERT LAWRENCE | 15409 SPENCERVILLE RD GRABIL, IN 46741 | AFLAC | $736 | $6 | $742 | 0.45% |
| DONALD E SPRINGER3 Filed as: DONALD SPRINGER | 5715 RIVER RUN TRL FORT WAYNE, IN 46825 | AFLAC | $709 | $25 | $734 | 0.44% |
| SARA BRITA3 | 1005 WESTCOTT DR FORT WAYNE, IN 46818 | AFLAC | $598 | — | $598 | 0.36% |
| KELLI CRAWFORD3 | 7330 HAWKSNEST TRL FORT WAYNE, IN 46835 | AFLAC | $250 | $220 | $470 | 0.28% |
| TERRY J SILVERS3 Filed as: TERRY SEILER | 1652 HOWELL ST FORT WAYNE, IN 46808 | AFLAC | $318 | $136 | $454 | 0.27% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN COURT | 11206 SHALIMAR DR FORT WAYNE, IN 46845 | AFLAC | $385 | — | $385 | 0.23% |
| NICHOLAS E VIGIL3 Filed as: NICHOLAS SHIPE | 11037 BROADWAY STE C CROWN POINT, IN 46307 | AFLAC | $336 | — | $336 | 0.20% |
| JONATHAN DAVID BESWARICK3 Filed as: JONATHAN BESWARICK | 250 ESTATES DR GIBSONIA, PA 15044 | AFLAC | $336 | — | $336 | 0.20% |
| AMY COALSON3 | 180 LANE 282 HAMILTON LK HAMILTON, IN 46742 | AFLAC | $137 | $117 | $254 | 0.15% |
| LESTES NIVENS3 | 1201 LIMBERLOST TRL ROME CITY, IN 46784 | AFLAC | $248 | — | $248 | 0.15% |
| JUSTIN C CARSON3 Filed as: JUSTIN FINTON | 112 S ANDERSON ST ELWOOD, IN 46036 | AFLAC | $237 | — | $237 | 0.14% |
| BRIAN DILL3 | 4614 N 615 W HUNTINGTON, IN 46750 | AFLAC | $226 | — | $226 | 0.14% |
| MICHELLE L SEXTON3 Filed as: MICHELLE SEXTON | 220 INSURANCE DR STE A FORT WAYNE, IN 46825 | AFLAC | $207 | — | $207 | 0.12% |
| MICHAEL MCEVOY3 | 376 N WALNUT ST COLUMBIA CITY, IN 46725 | AFLAC | $183 | — | $183 | 0.11% |
| CHARLES D. BLOCK3 Filed as: CHARLES GRAY | 3122 MARIAS DR FORT WAYNE, IN 46815 | AFLAC | $159 | — | $159 | 0.10% |
| RICHARD UHRICK3 | P.O. BOX 93 LAOTTO, IN 46763 | AFLAC | $155 | — | $155 | 0.09% |
| JEREMY JAY JOHNSON3 Filed as: JEREMY JOHNSON | 7263 BRAXTON DR NOBLESVILLE, IN 46062 | AFLAC | $143 | — | $143 | 0.09% |
| LORI MINYARD3 | 14420 ALLISON ROAD CARMEL, IN 46033 | AFLAC | $127 | — | $127 | 0.08% |
| JUSTIN D HARPER3 Filed as: JUSTIN HARPER | 220 INSURANCE DR STE A FORT WAYNE, IN 46825 | AFLAC | $118 | — | $118 | 0.07% |
| DOUGLAS FOX3 | 6836 THAYER LAKE DR ALDEN, MI 46912 | AFLAC | $102 | — | $102 | 0.06% |
| JEFFREY D HARNED3 Filed as: JEFFREY HINES | 6225 SUGAR TREE PL FORT WAYNE, IN 46835 | AFLAC | $91 | — | $91 | 0.05% |
| NAVILLE & ASSOCIATES3 | 5511 MOSER KNOB RD FLOYD KNOBS, IN 47119 | AFLAC | $88 | — | $88 | 0.05% |
| DAVID J MCCLELLAN3 Filed as: DAVID KREMER | 2150 ASSOCIATION DR STE 150 OKEMOS, MI 48864 | AFLAC | $77 | — | $77 | 0.05% |
| JUSTIN D HARPER3 Filed as: JUSTIN HARPER | 421 E COOK RD STE 400 FORT WAYNE, IN 46825 | AFLAC | $77 | — | $77 | 0.05% |
| JOHN D TYLER3 Filed as: JOHN TYLER & ASSOCATES | 2131 KILEY WAY EDMOND, OK 73034 | AFLAC | $67 | — | $67 | 0.04% |
| ROBIN M CALLAWAY3 Filed as: ROBIN ASKINS | 427 N LINCOLN PARK WARSAW, IN 46582 | AFLAC | $53 | — | $53 | 0.03% |
| CURTISS ANDERSON3 | 214 CLAIBORNE DR COLUMBIA CITY, IN 46725 | AFLAC | $51 | — | $51 | 0.03% |
| DANNY R. OSTER3 Filed as: DANNY WHITMIRE | 16474 PRETY VIEW DR PLYMOUTH, IN 46563 | AFLAC | $42 | — | $42 | 0.03% |
| CAROL PURDY FIELDS3 Filed as: CAROL THOMPSON | 51717 SUMMER WOOD CT GRANGER, IN 46530 | AFLAC | $33 | — | $33 | 0.02% |
| RUTH BOLARD3 | 8940A STATE ROUTE 34 YORKVILLE, IL 60560 | AFLAC | $31 | — | $31 | 0.02% |
| JOEL GOSS3 | 1363 JACOBS DR FORT WAYNE, IN 46814 | AFLAC | $26 | — | $26 | 0.02% |
| MARK A WOJDA3 Filed as: MARK MOJDA | 16258 DOGWOOD LN PLYMOUTH, IN 46563 | AFLAC | $25 | — | $25 | 0.02% |
| JOHN T CLANCY3 Filed as: JOHN CLANCY | 4025 PETE DYE BLVD CARMEL, IN 46033 | AFLAC | $25 | — | $25 | 0.02% |
| RODNEY RUBERG3 | 2692 W MIAMI TRAIL MARION, IN 46952 | AFLAC | $24 | — | $24 | 0.01% |
| CYNTHIA GRAY3 | 3122 MARIAS DR FORT WAYNE, IN 46815 | AFLAC | $24 | — | $24 | 0.01% |
| MATTHEW G BERGER3 Filed as: MATTHEW COOK | 10069 BENT TREE LANE FISHERS, IN 46037 | AFLAC | $21 | — | $21 | 0.01% |
| MATTHEW NACHAZEL3 | 16473 BAYWOOD LANE GRANGER, IN 46530 | AFLAC | $19 | — | $19 | 0.01% |
| GREGORY W ALDRICH3 Filed as: GREGORY ALDRICH | 615 PINE RUN ANGOLA, IN 46703 | AFLAC | $17 | — | $17 | 0.01% |
| JAMES M FLETCHER3 Filed as: JAMES FLETCHER | 7325 CLUBHOUSE DR FORT WAYNE, IN 46835 | AFLAC | $15 | — | $15 | 0.01% |
| AMY E COHEN3 Filed as: AMY GEHLHAUSEN | 3115 HOWARD DR JASPER, IN 47546 | AFLAC | $15 | — | $15 | 0.01% |
| JEFFREY LUXENBERG3 Filed as: JEFFREY LUXENBURG | 307 LONGTREE LANE LOGANSPORT, IN 46947 | AFLAC | $13 | — | $13 | 0.01% |
| KAREN SUE KIEFER3 Filed as: KAREN KIEFER | 2517 JACOBS CREEK RUN FORT WAYNE, IN 46825 | AFLAC | $12 | — | $12 | 0.01% |
| REBECCA MORRIS3 | 13566 ALICANTE WAY FORT WAYNE, IN 46845 | AFLAC | $12 | — | $12 | 0.01% |
| RONALD ALDRICH3 | 4675 W 100 S ANGOLA, IN 46703 | AFLAC | $12 | — | $12 | 0.01% |
| DERRICK T JACKSON3 Filed as: DERRICK JACKSON | P.O. BOX 10114 FORT WAYNE, IN 46850 | AFLAC | $11 | — | $11 | 0.01% |
| BRIANNA LYNN ROWE3 | 3386 CHALICE CT PLAINFIELD, IN 46168 | AFLAC | $9 | — | $9 | 0.01% |
| CHRISTINA JONES3 | 520 N MAIN ST RUSHVILLE, IN 46173 | AFLAC | $9 | — | $9 | 0.01% |
| PAUL MAMBU3 | 1004 THREE RIVERS E FORT WAYNE, IN 46802 | AFLAC | $7 | — | $7 | 0.00% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN GLAUB | 54369 30TH ST SOUTH BEND, IN 46635 | AFLAC | $7 | — | $7 | 0.00% |
| KYLE DUANE DAFLER3 | 2431 HAWKINS ROAD RICHMOND, IN 47374 | AFLAC | $5 | — | $5 | 0.00% |
| GREGORY W ALDRICH3 Filed as: GREGORY ALDRICH | 4675 W 100 S ANGOLA, IN 46703 | AFLAC | $4 | — | $4 | 0.00% |
| ASSUREDPARTNERS3 Filed as: JENNIFER MITCHEN | 9247 N MERIDIAN ST STE 205 INDIANAPOLIS, IN 46260 | AFLAC | $4 | — | $4 | 0.00% |
| DAYTON LLC3 | 5445 DTC PKWY STE 1036 GREENWOOD VILLAGE, CO 80111 | AFLAC | $4 | — | $4 | 0.00% |
| JACQUELINE CASTRO3 Filed as: JACQUELINE BEAULIEU | 131 E 39TH ST APT 3 NEW YORK, NY 16066 | AFLAC | $3 | — | $3 | 0.00% |
| CARRIE S FLATEN3 Filed as: CARRIE SCHRAMM | 10418 PRETY LAKE TRL PLYMOUTH, IN 46563 | AFLAC | $3 | — | $3 | 0.00% |
| TODD DEVOSS3 | 321 N CLARK ST STE 625 CHICAGO, IL 60654 | AFLAC | $3 | — | $3 | 0.00% |
| JOSPEH A NASCA3 Filed as: JOSPEH NASCA | 28081 W MAPLE AVE BARRINGTON, IL 60010 | AFLAC | $3 | — | $3 | 0.00% |
| BRIAN W PATTEN3 Filed as: BRIAN PATTEN | 120 MARGUERITE DR STE 101 CRANBERRY TOWNSHIP, PA 16066 | AFLAC | $3 | — | $3 | 0.00% |
| SOURCE ONE GROUP, LLC3 | 6628 CONSTITUTION DRIVE FORT WAYNE, IN 46804 | EYEMED VISION CARE | $8K | — | $8K | 10.77% |
| INNOVATIVE BROKER SOLUTIONS LTD3 Filed as: INNOVATIVE BROKER SOLUTIONS | 9405 BORMET DRIVE STE 3 MOKENA, IL 60448 | EYEMED VISION CARE | $2K | — | $2K | 3.23% |
| SOURCEONE GROUP LLC3 | 6228 CONSTITUTION DRIVE FORT WAYNE, IN 46804 | AFLAC | $1K | — | $1K | 5.07% |
| MOLLY KURTZ3 Filed as: MOLLY MARIE KURTZ | 1154 E 900 N OSSIAN, IN 46777 | AFLAC | $531 | $34 | $565 | 1.96% |
| DONALD E SPRINGER3 | 3670 SUN STONE WAY NEW HAVEN, IN 46774 | AFLAC | $385 | — | $385 | 1.34% |
| JOHNATHAN DAVID BESWARICK3 | 220 INSURANCE DRIVE FORT WAYNE, IN 46825 | AFLAC | $140 | $23 | $163 | 0.57% |
| ROBERT J LAWRENCE3 | 15409 SPENCERVILLE ROAD GRABILL, IN 46741 | AFLAC | $145 | $5 | $150 | 0.52% |
| NICHOLAS DEAN SHIPE3 | 11037 BROADWAY STE C CROWN POINT, IN 46307 | AFLAC | $136 | — | $136 | 0.47% |
| JUSTIN D HARPER3 | 220 INSURANCE DR STE A FORT WAYN, IN 46825 | AFLAC | $125 | — | $125 | 0.43% |
| DONALD E SPRINGER3 Filed as: DONALD SPRINGER | 5715 RIVER RUN TRL FORT WAYNE, IN 46825 | AFLAC | $113 | — | $113 | 0.39% |
| SARA BRITA3 | 1005 WESTCOTT DR FORT WAYNE, IN 46818 | AFLAC | $103 | — | $103 | 0.36% |
| JUSTIN E FINTON3 | 112 S ANDERSON ST ELWOOD, IN 46036 | AFLAC | $73 | — | $73 | 0.25% |
| KELLI CRAWFORD3 | 7330 HAWKSNEST TRIAL FORT WAYNE, IN 46835 | AFLAC | $33 | $31 | $64 | 0.22% |
| ERIC BROGAN3 Filed as: ERIC SPENGEL | 103 N MAIN ST STE 3 CROWN POINT, IN 46307 | AFLAC | $63 | — | $63 | 0.22% |
| JOHN W COURT3 | 11206 SHALIMAR DR FORT WAYNE, IN 46845 | AFLAC | $53 | — | $53 | 0.18% |
| JONATHAN DAVID BESWARICK3 Filed as: JONATHAN BESWARICK | 250 ESTATES DRIVE GIBSONIA, PA 15044 | AFLAC | $52 | — | $52 | 0.18% |
| MICHAEL MCEVOY3 | 376 N WALNUT ST COLUMBIA CITY, IN 46725 | AFLAC | $51 | — | $51 | 0.18% |
| DAVID J MCCLELLAN3 Filed as: DAVID KREMER | 2150 ASSOCIATION DR STE 150 OKEMOS, MI 48864 | AFLAC | $50 | — | $50 | 0.17% |
| ROBIN M CALLAWAY3 Filed as: ROBIN ASKINS | 427 N LINCOLN PARK WARSAW, IN 46582 | AFLAC | $42 | — | $42 | 0.15% |
| RICHARD UHRICK3 | P.O. BOX 93 LOTTO, IN 46763 | AFLAC | $40 | — | $40 | 0.14% |
| MICHELLE L SEXTON3 Filed as: MICHELLE E SEXTON | 220 INSURANCE DR STE A FORT WAYNE, IN 46825 | AFLAC | $36 | — | $36 | 0.12% |
| JEFFERY HINES3 | 6225 SUGAR TREE PL FORT WAYNE, IN 46835 | AFLAC | $34 | — | $34 | 0.12% |
| JUSTIN D HARPER3 Filed as: JUSTIN HARPER | 421 E COOK RD STE 400 FORT WAYNE, IN 46825 | AFLAC | $34 | — | $34 | 0.12% |
| TERRY J SILVERS Filed as: TERRY SEILER | 1652 HOWELL FORT WAYNE, IN 46808 | AFLAC | $15 | $16 | $31 | 0.11% |
| DANNY R. OSTER3 Filed as: DANNY WHITMIRE | 16474 PRETTY VIEW DRIVE PLYMOUTH, IN 46563 | AFLAC | $30 | — | $30 | 0.10% |
| JERRY DUNCAN3 Filed as: JERRY MACHAMER | 1405 CURDES AVE FORT WAYNE, IN 46805 | AFLAC | $24 | — | $24 | 0.08% |
| CHARLES D. BLOCK3 Filed as: CHARLES GRAY | 3122 MARIAS DR FORT WAYNE, IN 46815 | AFLAC | $20 | — | $20 | 0.07% |
| CURTISS ANDERSON3 | 214 CLAIBORNE DR COLUMBIA CITY, IN 46725 | AFLAC | $17 | — | $17 | 0.06% |
| NAVILLE & ASSOCIATES3 | 5511 MOSER KNOB ROAD FLOYDS KNOBS, IN 47116 | AFLAC | $16 | — | $16 | 0.06% |
| CAROL PURDY FIELDS3 Filed as: CAROL THOMPSON | 51717 SUMMER WOOD CT GRANGER, IN 46530 | AFLAC | $16 | — | $16 | 0.06% |
| LORI MINYARD3 | 14420 ALLISON DRIVE CARMEL, IN 46033 | AFLAC | $15 | — | $15 | 0.05% |
| BRIAN DILL3 | 4614 N 615 W HUNTINGTON, IN 46750 | AFLAC | $12 | — | $12 | 0.04% |
| LESTES NIVENS3 | 1201 LIMBERLOST TRL ROME CITY, IN 46784 | AFLAC | $12 | — | $12 | 0.04% |
| REBECCA MORRIS3 | 13566 ALICANTE WAY FORT WAYNE, IN 46845 | AFLAC | $11 | — | $11 | 0.04% |
| AMY COALSON3 | 180 LANE 282 HAMILTON LK HAMILTON, IN 46742 | AFLAC | $4 | $6 | $10 | 0.03% |
| DOUGLAS FOX3 | 6836 THAYER LAKE DR ALDEN, MI 49612 | AFLAC | $10 | — | $10 | 0.03% |
| MARK A WOJDA3 Filed as: MARK WOJDA | 16258 DOGWOOD LANE PLYMOUTH, NE 46563 | AFLAC | $6 | — | $6 | 0.02% |
| JOHN T CLANCY3 Filed as: JOHN CLANCY | 4025 PETE DYE BLVD CARMEL, IN 46033 | AFLAC | $6 | — | $6 | 0.02% |
| JOHN TYLER & ASSOCIATES3 Filed as: JOHN TYLER AND ASSOCIATES | 2131 KILEY WAY EDMOND, OK 73034 | AFLAC | $6 | — | $6 | 0.02% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN GLAUB | 54369 30TH STREET SOUTH BEND, IN 46635 | AFLAC | $5 | — | $5 | 0.02% |
| JACQUELINE GELINAS BEAULIEU3 | 131 E 39TH ST APT 3 NEW YORK, NY 10016 | AFLAC | $3 | — | $3 | 0.01% |
| TODD DEVOSS3 | 321 N CLARK ST STE 625 CHICAGO, IL 60010 | AFLAC | $3 | — | $3 | 0.01% |
| JOSEPH P CALARCO3 Filed as: JOSEPH NASCA | 28081 W MAPLE DRIVE BARRINGTON, IL 60010 | AFLAC | $3 | — | $3 | 0.01% |
| BRIAN W PATTEN3 Filed as: BRIAN PATTEN | 120 MARGUERITE DR STE 101 CRANBERRY TOWNSHIP, PA 16066 | AFLAC | $3 | — | $3 | 0.01% |
| AMY E COHEN3 Filed as: AMY GEHLHAUSEN | 3115 HOWARD DR JASPER, IN 47546 | AFLAC | $3 | — | $3 | 0.01% |
| ASSUREDPARTNERS3 Filed as: JENNIFER MITCHEN | 9247 N MERIDIAN ST STE 205 INDIANAPOLIS, IN 46260 | AFLAC | $2 | — | $2 | 0.01% |
| MATTHEW NACHAZEL3 | 16473 BAYWOOD LANE GRANGER, IN 46563 | AFLAC | $2 | — | $2 | 0.01% |
| CARRIE S FLATEN3 Filed as: CARRIE SCHRAMM | 10418 PRETTY LAKE TRIAL PLYMOUTH, IN 46563 | AFLAC | $2 | — | $2 | 0.01% |
| DAYTON LLC3 | 5445 DTC PARKWAY STE 1036 GREENWOOD VILLAGE, CO 80111 | AFLAC | $2 | — | $2 | 0.01% |
| BRIANNA LYNN ROWE3 | 3386 CHALICE CT PLAINFIELD, IN 46168 | AFLAC | $1 | — | $1 | 0.00% |
| MATTHEW G BERGER3 Filed as: MATTHEW COOK | 10069 BENT TREE LANE FISHERS, IN 46037 | AFLAC | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS, INC EIN 35-0145036 NONE | Contract Administrator Service code 13 | — | $192K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 NONE | Contract Administrator Service code 13 | — | $89K |
| SOURCEONE GROUP EIN 35-2155556 NONE | Insurance agents and brokers Service code 22 | — | $82K |
| THREE RIVERS PREFERRED EIN 35-0234810 NONE | Contract Administrator Service code 13 | — | $36K |
| PARKVIEW SIGNATURE CARE EIN 35-0952999 NONE | Contract Administrator Service code 13 | — | $27K |
| LUTHERN PREFERRED EIN 35-0234810 NONE | Contract Administrator Service code 13 | — | $3K |
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 | 913 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 921 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMPANION LIFE INSURANCE | 913 | $514K |
| Vision | EYEMED VISION CARE | 1,373 | $73K |
| Life insurance | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,031 | $693K |
| Long-term disability | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,031 | $693K |
| Other(3 contracts, 2 carriers) | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,031 | $888K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,373 | — |
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.