| 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 | $12K | $1K | $14K | 9.16% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE RD, STE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $12K | $1K | $14K | 9.15% |
| HILB GROUP OF NEW ENGLAND3 Filed as: THE HILB GROUP OF INDIANA, LLC | PO BOX 88 COLUMBIA CITY, IN 46725 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11K | — | $11K | 7.24% |
| 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 | $8K | — | $8K | 6.85% |
| 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 | $14K | — | $14K | 15.00% |
| CHARLES D. BLOCK3 Filed as: CHARLES D BLOCK | 648 VILLAGE PARK DR UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $562 | $6K | 8.41% |
| JAMES H. VAN EPPS3 Filed as: JAMES H VAN EPPS | 10930 CRABAPPLE RD, STE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $555 | $6K | 8.40% |
| 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 | $5K | — | $5K | 6.56% |
| UNIFIED GROUP SERVICES, INC.3 | 3131 EAST 67TH STREET ANDERSON, IN 46013 | HCC LIFE INSURANCE COMPANY | $7K | $1K | $8K | 11.80% |
| 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 | $114K |
| DELTA DENTAL OF INDIANA EIN 35-1545647 NONE | Contract Administrator; Claims processing Service code 12 | 4100 OKEMOS ROAD OKEMOS, MI 48864 | $17K |
| ELIXIR SOLUTIONS EIN 90-1011712 NONE | Claims processing; Contract Administrator Service code 12 | 7835 FREEDOM AVE NW NORTH CANTON, OH 44720 | $17K |
| BAEN, GAGE & SCHROEDER EIN 35-1939627 NONE | Accounting (including auditing) Service code 10 | 6920 POINTE INVERNESS WAY FORT WAYNE, IN 46804 | $17K |
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 | 646 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 650 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 346 | $22K |
| Life insurance(3 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 646 | $350K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 461 | $112K |
| Stop-loss / reinsurancereinsurance | SIRIUS AMERICA INSURANCE COMPANY | 230 | $563K |
| Other(5 contracts, 3 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 646 | $490K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 646 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.