| 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 | $1K | $12K | 8.80% |
| 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 | $1K | $12K | 8.68% |
| 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 | 6.98% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF INDIANA, LLC | PO BOX 88 COLUMBIA CITY, IN 46725 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $789 | $8K | 8.56% |
| 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 | $13K | $651 | $14K | 17.19% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $553 | $6K | 8.53% |
| 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 | $476 | $6K | 8.41% |
| 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 | 6.61% |
| UNIFIED GROUP SERVICES, INC.3 | 3131 EAST 67TH STREET ANDERSON, IN 46013 | HCC LIFE INSURANCE COMPANY | $7K | $886 | $7K | 11.34% |
| 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 | — | $138 | $138 | 0.75% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNIFIED GROUP SERVICES, INC. EIN 35-1973675 NONE | Claims processing; Contract Administrator Service code 12 | PO BOX 10 PENDLETON, IN 46064 | $111K |
| BAEN, GAGE & SCHROEDER EIN 35-1939627 NONE | Accounting (including auditing) Service code 10 | 6920 POINTE INVERNESS WAY FORT WAYNE, IN 46804 | $17K |
| DELTA DENTAL NONE | Claims processing; Contract Administrator Service code 12 | 4100 OKEMOS ROAD OKEMOS, MI 48864 | $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 | 608 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 615 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 308 | $18K |
| Life insurance(3 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 608 | $316K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 459 | $97K |
| Stop-loss / reinsurancereinsurance | SIRIUS AMERICA INSURANCE COMPANY | 222 | $673K |
| Other(5 contracts, 3 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 608 | $449K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 608 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.