| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JA BENEFITS LLC | PO BOX 159 BEDFORD, IN 47421 | ANTHEM INSURANCE COMPANIES INC | $26K | — | $26K | 2.45% |
| JA BENEFITS LLC3 | 1630 H STREET BEDFORD, IN 47421 | DELTA DENTAL OF INDIANA | — | — | $0 | 0.00% |
| ASSUREDPARTNERS3 Filed as: SHEPHERD INSURANCE LLC | 111 CONGRESSIONAL BLVD STE 100 CARMEL, IN 46032 | STANDARD LIFE INSURANCE COMPANY | $5K | — | $5K | 8.15% |
| NFP INSURANCE SERVICES INC3 | BLDG 2 STE 125 1250 CAPITAL OF TX HWY AUSTIN, TX 78746 | STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 1.98% |
| KYLE ELLISON3 Filed as: KYLE R ELLISON | 1281 E MARIGOLD DR BLOOMINGTON, IN 47401 | AFLAC | $3K | $241 | $3K | 8.00% |
| ROBERT W BURGETT3 | 1701 W 18TH ST STE A INDIANAPOLIS, IN 46202 | AFLAC | $776 | $47 | $823 | 2.06% |
| PETER J EMMERT3 | 5904 OAKFORGE LN INDIANAPOLIS, IN 46254 | AFLAC | $252 | $15 | $267 | 0.67% |
| ASSUREDPARTNERS3 Filed as: SHEPHERD INS LLC | 1200 W CARMEL DR CARMEL, IN 46032 | AFLAC | $247 | $0 | $247 | 0.62% |
| JUSTIN BOENITZ3 | 290 S UNION ST APT 2 BLOOMINGTON, IN 47408 | AFLAC | $178 | $0 | $178 | 0.45% |
| INDIANA PROFIT SOLUTIONS INC3 | 4030 LUCKY LN GREENWOOD, IN 46142 | AFLAC | $153 | $0 | $153 | 0.38% |
| MICHAEL DUANE ARNOLD3 | 2147 BUTTONBUSH DR PLAINFIELD, IN 46168 | AFLAC | $126 | $0 | $126 | 0.32% |
| LEILANI CALIA CHILDS3 | 8622 HAY MEADOW CT INDIANAPOLIS, IN 46227 | AFLAC | $69 | $0 | $69 | 0.17% |
| BRIANNA LYNN ROWE3 | 3386 CHALICE CT PLAINFIELD, IN 46268 | AFLAC | $52 | $0 | $52 | 0.13% |
| NAVILLE & ASSOCIATES3 | 5511 MOSER KNOB RD FLOYDS KNOBS, IN 47119 | AFLAC | $50 | $0 | $50 | 0.13% |
| PERENNIAL INS AGENCY COMPANY3 | 803 OYSTER CREEK DR SUGAR LAND, TX 77478 | AFLAC | $33 | $0 | $33 | 0.08% |
| MATTHEW A COOK3 | 10069 BENT TREE LN FISHERS, IN 46038 | AFLAC | $22 | $0 | $22 | 0.06% |
| DENTON J GILES3 | 4526 BROOK SHADOW DR KINGWOOD, TX 77345 | AFLAC | $18 | $0 | $18 | 0.05% |
| JOHN T CLANCY3 | 4025 PETE DYE BLVD CARMEL, IN 46033 | AFLAC | $17 | $0 | $17 | 0.04% |
| MARK A WOJDA3 | 631 GREENFORD TRL W CARMEL, IN 46032 | AFLAC | $17 | $0 | $17 | 0.04% |
| JENNIFER L MITCHEN3 | 9247 N MERIDIAN ST STE 205 INDIANAPOLIS, IN 46260 | AFLAC | $16 | $0 | $16 | 0.04% |
| DANIEL R HARPER JR3 | 101 WINDSONG CT GASTONIA, NC 28056 | AFLAC | $15 | $0 | $15 | 0.04% |
| DAVID LEVERENZ3 | 2146 S OAKDALE DR BLOOMINGTON, IN 47403 | AFLAC | $13 | $0 | $13 | 0.03% |
| RYAN E FRAZIER3 | 220 STONEGATE LN APT B INDIANAPOLIS, IN 46227 | AFLAC | $11 | $0 | $11 | 0.03% |
| JOHN P WHELAN3 | 15129 GOODTIME CT CARMEL, IN 46032 | AFLAC | $6 | $0 | $6 | 0.02% |
| KEVIN F WARD3 | 12632 DOUBLE EAGLE DR CARMEL, IN 46033 | AFLAC | $5 | $0 | $5 | 0.01% |
| BRYAN W HARPER3 | 921 YELLOW PINE CT INDIANAPOLIS, IN 46217 | AFLAC | $4 | $0 | $4 | 0.01% |
| HYLANT GROUP INC3 | PO BOX 40925 INDIANAPOLIS, IN 46240 | AFLAC | $3 | $0 | $3 | 0.01% |
| THOMAS ALEX SHEVLOT3 | 9242 MEMORIAL PARK DR INDIANAPOLIS, IN 46216 | AFLAC | $1 | $0 | $1 | 0.00% |
| RITA J ABRAM3 | 11500 GOLDEN WILLOW CT ZIONSVILLE, IN 46077 | AFLAC | $1 | $0 | $1 | 0.00% |
| AMY N GEHLHAUSEN3 | 3115 HOWARD DR JASPER, IN 47546 | AFLAC | $1 | $0 | $1 | 0.00% |
| ASSUREDPARTNERS3 Filed as: SHEPHERD INSURANCE LLC | 111 CONGRESSIONAL BLVD STE 100 CARMEL, IN 46032 | STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 6.94% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP INSURANCE SERVICES | BLDG 2 STE 125 1250 CAPITAL OF TX HWY AUSTIN, TX 78746 | STANDARD LIFE INSURANCE COMPANY | $675 | — | $675 | 1.99% |
| JA BENEFITS LLC3 | PO BOX 159 BEDFORD, IN 474210159 | VISION SERVICE PLAN | $261 | — | $261 | 2.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TOTAL ADMINISTRATIVE SERVICES CORP EIN 39-1561025 NONE | Contract Administrator Service code 13 | 2302 INTERNATIONAL LANE MADISON, WI 53704 | $6K |
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 | 157 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 158 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES INC | 163 | $1.1M |
| Dental | DELTA DENTAL OF INDIANA | 170 | $66K |
| Vision | VISION SERVICE PLAN | 97 | $10K |
| Life insurance | STANDARD LIFE INSURANCE COMPANY | 159 | $34K |
| Short-term disability | AFLAC | 47 | $40K |
| Long-term disability | STANDARD LIFE INSURANCE COMPANY | 159 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 170 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.