| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JA BENEFITS LLC3 | 1630 H STREET BEDFORD, IN 47421 | ANTHEM INSURANCE COMPANIES, INC. | $32K | — | $32K | 3.01% |
| JA BENEFITS LLC3 Filed as: JA BENEFITS, LLC | PO BOX 159 BEDFORD, IN 47421 | DELTA DENTAL OF INDIANA | — | $44 | $44 | 0.07% |
| ASSUREDPARTNERS3 Filed as: SHEPHERD INSURANCE LLC | 111 CONGRESSIONAL BOULEVARD SUITE 10 CARMEL, IN 46032 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $1K | $9K | 17.00% |
| KYLE ELLISON3 Filed as: KYLE R ELLISON | 1281 EAST MARIGOLD DRIVE BLOOMINGTON, IN 47401 | AFLAC | $2K | $49 | $2K | 8.25% |
| ROBERT W BURGETT3 | 1701 WEST 18TH STREET SUITE A INDIANAPOLIS, IN 46202 | AFLAC | $582 | $12 | $594 | 2.02% |
| JEANA ANN DELANEY3 | 9386 SOUTH LAKE RIDGE DRIVE UNIT 91 BLOOMINGTON, IN 47401 | AFLAC | $358 | — | $358 | 1.22% |
| ASSUREDPARTNERS3 Filed as: SHEPHERD INS LLC | 111 CONGRESSIONAL BOULEVARD SUITE 100 CARMEL, IN 46032 | AFLAC | $217 | — | $217 | 0.74% |
| PETER J EMMERT3 | 5904 OAKFORGE LANE INDIANAPOLIS, IN 46254 | AFLAC | $101 | — | $101 | 0.34% |
| BRIANNA LYNN ROWE3 | 3386 CHALICE COURT PLAINFIELD, IN 46168 | AFLAC | $52 | — | $52 | 0.18% |
| PATRICIA ANN JONES3 | 10165 HAREWOOD DRIVE SOUTH NOBLESVILLE, IN 46060 | AFLAC | $37 | — | $37 | 0.13% |
| PERENNIAL INS AGENCY COMPANY3 | 803 OYSTER CREEK DRIVE SUGAR LAND, TX 77478 | AFLAC | $33 | — | $33 | 0.11% |
| NAVILLE & ASSOCIATES3 | 5511 MOSER KNOB ROAD FLOYDS KNOBS, IN 47119 | AFLAC | $31 | — | $31 | 0.11% |
| MICHAEL DUANE ARNOLD3 | 2147 BUTTONBUSH DRIVE PLAINFIELD, IN 46168 | AFLAC | $28 | — | $28 | 0.10% |
| DENTON J GILES3 | 4526 BROOK SHADOW DRIVE KINGWOOD, TX 77345 | AFLAC | $18 | — | $18 | 0.06% |
| DANIEL R HARPER JR3 | 101 WINDSONG COURT GASTONIA, NC 28056 | AFLAC | $14 | — | $14 | 0.05% |
| MARK A WOJDA3 | 16258 DOGWOOD LANE PLYMOUTH, IN 46563 | AFLAC | $11 | — | $11 | 0.04% |
| MATTHEW A COOK3 | 10069 BENT TREE LANE FISHERS, IN 46037 | AFLAC | $11 | — | $11 | 0.04% |
| JOHN T CLANCY3 | 4025 PETE DYE BOULEVARD CARMEL, IN 46033 | AFLAC | $10 | — | $10 | 0.03% |
| JENNIFER L MITCHEN3 | 9247 NORTH MERIDIAN STREET SUITE 205 INDIANAPOLIS, IN 46260 | AFLAC | $10 | — | $10 | 0.03% |
| JOHN P WHELAN3 | 15129 GOODTIME COURT CARMEL, IN 46032 | AFLAC | $6 | — | $6 | 0.02% |
| DAVID LEVERENZ3 | 2146 SOUTH OAKDALE DRIVE BLOOMINGTON, IN 47403 | AFLAC | $5 | — | $5 | 0.02% |
| RYAN E FRAZIER3 | 220 STONEGATE LANE APARTMENT B INDIANAPOLIS, IN 46227 | AFLAC | $4 | — | $4 | 0.01% |
| HYLANT GROUP INC3 | PO BOX 40925 INDIANAPOLIS, IN 46240 | AFLAC | $3 | — | $3 | 0.01% |
| AMY N GEHLHAUSEN3 | 3115 HOWARD DRIVE JASPER, IN 47546 | AFLAC | $1 | — | $1 | 0.00% |
| JA BENEFITS LLC3 Filed as: JA BENEFITS, LLC | PO BOX 159 BEDFORD, IN 47421 | VISION SERVICE PLAN | $800 | — | $800 | 7.40% |
| D'ANN DABELL3 Filed as: D ANN DABELL | 1174 NORTH 2000 EAST LAYTON, UT 84040 | PRE-PAID LEGAL SERVICES INC DBA LEAGALSHIELD | $60 | — | $60 | 3.92% |
| JULIA VON BARGEN3 | 5 GREEN PLACE CARMEL, IN 46033 | PRE-PAID LEGAL SERVICES INC DBA LEAGALSHIELD | $22 | — | $22 | 1.44% |
No Schedule C service providers reported on this filing.
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 | 151 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 98 | $1.1M |
| Dental | DELTA DENTAL OF INDIANA | 184 | $65K |
| Vision | VISION SERVICE PLAN | 97 | $11K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 156 | $55K |
| Short-term disability | AFLAC | 34 | $29K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 156 | $55K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 156 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 184 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.