| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ESTLICK GIRVIN & LEFEVER3 Filed as: ESTLICK GIRVIN & LEFEVER, INC. | 102 W VAN BUREN ST COLUMBIA CITY, IN 46725 | UNUM LIFE INSURANCE COMPANY OF AMERICA, | $8K | $812 | $8K | 7.75% |
| ESTLICK GIRVIN & LEFEVER3 Filed as: ESTLICK GIRVIN & LEFEVER, INC. | 102 W VAN BUREN ST COLUMBIA CITY, IN 46725 | UNUM LIFE INSURANCE COMPANY OF AMERICA, | $15K | $755 | $16K | 15.79% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY, | $11K | $1K | $12K | 13.86% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE RD, STE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY, | $11K | $492 | $12K | 13.24% |
| ESTLICK GIRVIN & LEFEVER3 Filed as: ESTLICK GIRVIN & LEFEVER, INC. | 102 W VAN BUREN ST COLUMBIA CITY, IN 46725 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY, | $10K | — | $10K | 11.45% |
| UNIFIED GROUP SERVICES, INC.3 | 3131 EAST 67TH STREET ANDERSON, IN 46013 | HCC LIFE INSURANCE COMPANY, | $7K | $1K | $9K | 11.80% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA, | $7K | $756 | $8K | 16.37% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE RD, STE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA, | $7K | $368 | $8K | 15.59% |
| ESTLICK GIRVIN & LEFEVER3 Filed as: ESTLICK GIRVIN & LEFEVER, INC. | 102 W VAN BUREN ST COLUMBIA CITY, IN 46725 | UNUM LIFE INSURANCE COMPANY OF AMERICA, | $6K | — | $6K | 12.91% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNIFIED GROUP SERVICES, INC. EIN 35-1973675 NONE | Contract Administrator; Claims processing Service code 12 | PO BOX 10 PENDLETON, IN 46064 | $105K |
| DELTA DENTAL NONE | Claims processing Service code 12 | 4100 OKEMOS ROAD OKEMOS, MI 48864 | $19K |
| BAEN, GAGE & SCHROEDER EIN 35-1939627 NONE | Accounting (including auditing) Service code 10 | 6920 POINTE INVERNESS WAY FORT WAYNE, IN 46804 | $14K |
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 | 506 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 510 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | STARMOUNT LIFE INSURANCE COMPANY, | 364 | $22K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA, | 506 | $299K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA, | 506 | $108K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY, | 235 | $465K |
| Other(5 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA, | 506 | $421K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 506 | — |
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.