| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OLD NATIONAL INSURANCE GROUP3 | 925 WABASH AVENUE SUITE 200 TERRE HAUTE, IN 47807 | ANTHEM INSURANCE COMPANIES, INC. | $13K | — | $13K | 1.79% |
| ONB INSURANCE GROUP INC.3 | 1111 CHESTNUT HILLS PARKWAY FORT WAYNE, IN 46814 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | $4K | $10K | 16.69% |
| LYNN M STEPPE3 | 1208 NORTH FARRIER STREET TERRE HAUTE, IN 47803 | AFLAC | $2K | $36 | $2K | 13.35% |
| WILLIAM RICHARD ELDEN3 | 400 WABASH AVENUE SUITE 10B TERRE HAUTE, IN 47807 | AFLAC | $553 | $12 | $565 | 4.74% |
| ROBERT W BURGETT3 | 2601 FORTUNE CIRCLE EAST SUITE 103A INDIANAPOLIS, IN 46241 | AFLAC | $344 | $12 | $356 | 2.99% |
| ONB INSURANCE GROUP INC.3 | P.O. BOX 1488 TERRE HAUTE, IN 47808 | AFLAC | $325 | — | $325 | 2.73% |
| JOHN SCHULZ3 | 7241 WOODCRAFT COURT TERRE HAUTE, IN 47802 | AFLAC | $86 | $25 | $111 | 0.93% |
| LARRY P WYNDHAM3 | 55 SOUTH FOREST AVENUE BRAZIL, IN 47834 | AFLAC | $62 | — | $62 | 0.52% |
| PETER J EMMERT3 | 2601 FORTUNE CIRCLE EAST SUITE 103A INDIANAPOLIS, IN 46241 | AFLAC | $48 | — | $48 | 0.40% |
| THOMAS H SWAN3 | 4317 GOLF BAG LANE TERRE HAUTE, IN 47802 | AFLAC | $48 | — | $48 | 0.40% |
| JAMES A BURRESS3 | 6418 FAYBOROUGH COURT DUBLIN, OH 43016 | AFLAC | $24 | — | $24 | 0.20% |
| WARREN REID HAVENOR3 | 8777 PURDUE ROAD SUITE 104 INDIANAPOLIS, IN 46268 | AFLAC | $24 | — | $24 | 0.20% |
| J THEIS & ASSOCIATES INC3 Filed as: J THEIS & ASSOCIATES INC. | 2048 OVERLAND AVENUE SUITE 202 BILLINGS, MT 59102 | AFLAC | $16 | — | $16 | 0.13% |
| KEVIN M VERST3 Filed as: KEVIN V VERST | 4573 IRONWOOD LANE TERRE HAUTE, IN 47802 | AFLAC | $16 | — | $16 | 0.13% |
| TIMOTHY B ASBY3 | 9247 NORTH MERIDIAN STREET SUITE 205 INDIANAPOLIS, IN 46260 | AFLAC | $10 | $5 | $15 | 0.13% |
| JEFFREY D BRINDLE3 | 10811 LAKEVIEW DRIVE CARMEL, IN 46033 | AFLAC | $13 | — | $13 | 0.11% |
| ROBERT E JONES3 | 55 SOUTH FOREST AVENUE BRAZIL, IN 47834 | AFLAC | $12 | — | $12 | 0.10% |
| JOHN D TYLER3 | 130 DUCK HAWK WAY MARIETTA, SC 29661 | AFLAC | $11 | — | $11 | 0.09% |
| FRANCES R WYNDHAM3 | 1101 WEST PARK AVENUE BRAZIL, IN 47834 | AFLAC | $10 | — | $10 | 0.08% |
| NAVILLE & ASSOCIATES3 | 14220 OVERBROOK DRIVE CARMEL, IN 46074 | AFLAC | $9 | — | $9 | 0.08% |
| LLOYD W HUGHES3 | 3775 NORTH STATE ROAD 52 LEBANON, IN 46052 | AFLAC | $5 | — | $5 | 0.04% |
| HARROLD/HUGHES INSURANCE3 Filed as: HARROLD HUGHES INSURANCE | 3775 NORTH US 52 LENANON, IN 46052 | AFLAC | $5 | — | $5 | 0.04% |
| JOHN TYLER & ASSOCIATES3 | 130 DUCK HAWK WAY MARIETTA, SC 29661 | AFLAC | $2 | — | $2 | 0.02% |
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 | 102 | 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) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 96 | $705K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 102 | $59K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 102 | $59K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 102 | $59K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 102 | $59K |
| Prescription drug | ANTHEM INSURANCE COMPANIES, INC. | 96 | $705K |
| Other(3 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 102 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 102 | — |
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.