| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11K | $935 | $12K | 9.55% |
| 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 | $701 | $12K | 9.37% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF INDIANA, LLC | 102 W VAN BUREN ST COLUMBIA CITY, IN 46725 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10K | — | $10K | 7.78% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF INDIANA, LLC | 102 W VAN BUREN ST COLUMBIA CITY, IN 46725 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $713 | $8K | 7.70% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF INDIANA, LLC | 102 W VAN BUREN ST COLUMBIA CITY, IN 46725 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | $625 | $13K | 14.49% |
| UNIFIED GROUP SERVICES, INC.3 | 3131 EAST 67TH STREET ANDERSON, IN 46013 | HCC LIFE INSURANCE COMPANY | $7K | $1K | $8K | 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 | $5K | $385 | $5K | 8.36% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE RD, STE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $291 | $5K | 8.21% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF INDIANA, LLC | 102 W VAN BUREN ST COLUMBIA CITY, IN 46725 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 6.67% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF INDIANA, LLC | 102 W VAN BUREN ST COLUMBIA CITY, IN 46725 | STARMOUNT LIFE INSURANCE COMPANY | — | $185 | $185 | 0.75% |
| 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 | $139K |
| DELTA DENTAL NONE | Contract Administrator; Claims processing Service code 12 | 4100 OKEMOS ROAD OKEMOS, MI 48864 | $16K |
| BAEN, GAGE & SCHROEDER EIN 35-1939627 NONE | Accounting (including auditing) Service code 10 | 6920 POINTE INVERNESS WAY FORT WAYNE, IN 46804 | $16K |
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 | 595 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 600 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 358 | $25K |
| Life insurance(3 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 595 | $323K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 481 | $103K |
| Stop-loss / reinsurancereinsurance | SIRIUS AMERICA INSURANCE COMPANY | 218 | $596K |
| Other(5 contracts, 3 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 595 | $453K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 595 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.