| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ESTLICK GIRVIN & LEFEVER3 | 201 W. VAN BUREN STREET COLUMBIA CITY, IN 46725 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $15K | — | $15K | 15.00% |
| ESTLICK GIRVIN & LEFEVER3 | 201 W. VAN BUREN STREET COLUMBIA CITY, IN 46725 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 8.17% |
| ESTLICK GIRVIN & LEFEVER3 | 201 W. VAN BUREN STREET COLUMBIA CITY, IN 46725 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $992 | — | $992 | 2.23% |
| ESTLICK GIRVIN & LEFEVER3 Filed as: ESTLICK-GIRVIN & LEFEVER, INC | 201 W VAN BUREN STREET COLUMBIA CITY, IN 46725 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $364 | — | $364 | 4.28% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AUTOMATED GROUP ADMINISTRATION EIN 35-1802248 | Claims processing; Contract Administrator Service code 12 | 7605 WESTFIELD DRIVE FORT WAYNE, IN 46825 | $129K |
| DELTA DENTAL | Claims processing Service code 12 | 4100 OKEMOS ROAD OKEMOS, MI 48864 | $20K |
| BADEN, GAGE & SCHROEDER EIN 35-1939627 | Accounting (including auditing) Service code 10 | 6920 POINTE INVERNESS WAY FORT WAYNE, IN 46804 | $11K |
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 | 755 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 760 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 511 | $228K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 511 | $86K |
| Stop-loss / reinsurancereinsurance | MONUMENTAL LIFE INSURANCE COMPANY | 402 | $384K |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 511 | $237K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 511 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.