| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | P.O. BOX 3430 INDIANAPOLIS, IN 46250 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $7K | $35K | $42K | 3.24% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | PO BOX 3430 CARMEL, IN 46082 | KAISER FOUNDATION HEALTH PLAN INC. | $17K | — | $17K | 3.15% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | PO BOX 3430 CARMEL, IN 46082 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $622 | $9K | 16.10% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | PO BOX 3430 CARMEL, IN 46082 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $254 | $3K | 16.25% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | PO BOX 3430 CARMEL, IN 46082 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $198 | $2K | 16.97% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | PO BOX 3430 CARMEL, IN 46082 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $396 | $192 | $588 | 7.43% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | PO BOX 3430 CARMEL, IN 46082 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $43 | $70 | $113 | 13.23% |
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 | 180 | 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) | 180 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 180 | $1.8M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 180 | $1.3M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 180 | $1.3M |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 180 | $64K |
| Short-term disability | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 180 | $5K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 180 | $20K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 180 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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.