| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JA BENEFITS LLC3 | 1630 H STREET BEDFORD, IN 47421 | ANTHEM INSURANCE COMPANIES, INC. | $35K | — | $35K | 3.07% |
| ASSUREDPARTNERS3 Filed as: SHEPHERD INSURANCE LLC | 111 CONGRESSIONAL BOULEVARD SUITE 10 CARMEL, IN 46032 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $2K | $12K | 17.48% |
| KYLE ELLISON3 Filed as: KYLE R ELLISON | 1281 EAST MARIGOLD DRIVE BLOOMINGTON, IN 47401 | AFLAC | $2K | $122 | $2K | 6.02% |
| PATRICIA ANN JONES3 | 10165 HAREWOOD DRIVE SOUTH NOBLESVILLE, IN 46060 | AFLAC | $616 | $10 | $626 | 2.02% |
| ROBERT W BURGETT3 | 1701 WEST 18TH STREET SUITE A INDIANAPOLIS, IN 46202 | AFLAC | $533 | $38 | $571 | 1.84% |
| ASSUREDPARTNERS3 Filed as: SHEPHERD INS LLC | 111 CONGRESSIONAL BOULEVARD SUITE 200 CARMEL, IN 46032 | AFLAC | $194 | — | $194 | 0.62% |
| RITA J ABRAM3 | 11500 GOLDEN WILLOW COURT ZIONSVILLE, IN 46077 | AFLAC | $112 | — | $112 | 0.36% |
| JEANA ANN DELANEY3 | 9386 SOUTH LAKE RIDGE DRIVE UNIT 91 BLOOMINGTON, IN 47401 | AFLAC | $43 | $42 | $85 | 0.27% |
| PETER J EMMERT3 | 5904 OAKFORGE LANE INDIANAPOLIS, IN 46254 | AFLAC | $76 | — | $76 | 0.24% |
| BRIANNA LYNN ROWE3 | 3386 CHALICE COURT PLAINFIELD, IN 46168 | AFLAC | $56 | — | $56 | 0.18% |
| PERENNIAL INS AGENCY COMPANY3 Filed as: PERENNIAL INSURANCE AGENCY COMPANY | 803 OYSTER CREEK DRIVE SUGAR LAND, TX 77478 | AFLAC | $36 | — | $36 | 0.12% |
| MICHAEL DUANE ARNOLD3 | 2147 BUTTONBUSH DRIVE PLAINFIELD, IN 46168 | AFLAC | $30 | — | $30 | 0.10% |
| NAVILLE & ASSOCIATES3 | 5511 MOSER KNOB ROAD FLOYDS KNOBS, IN 47119 | AFLAC | $27 | — | $27 | 0.09% |
| DENTON J GILES3 | 4526 BROOK SHADOW DRIVE KINGWOOD, TX 77345 | AFLAC | $20 | — | $20 | 0.06% |
| DANIEL R HARPER JR3 | 101 WINDSONG COURT CASTONIA, NC 28056 | AFLAC | $11 | — | $11 | 0.04% |
| MARK A WOJDA3 | 16258 DOGWOOD LANE PLYMOUTH, IN 46563 | AFLAC | $10 | — | $10 | 0.03% |
| MATTHEW A COOK3 | 10069 BENT TREE LANE FISHERS, IN 46037 | AFLAC | $10 | — | $10 | 0.03% |
| 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 | $9 | — | $9 | 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 | $6 | — | $6 | 0.02% |
| 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 | $814 | — | $814 | 7.08% |
| D'ANN DABELL3 Filed as: D ANN DABELL | 1174 NORTH 2000 EAST LAYTON, UT 84040 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $163 | — | $163 | 14.55% |
| JULIA VON BARGEN3 | 5 GREEN PLACE CARMEL, IN 46033 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $100 | — | $100 | 8.93% |
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 | 152 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 153 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 103 | $1.1M |
| Dental | DELTA DENTAL OF INDIANA | 180 | $68K |
| Vision(2 contracts, 2 carriers) | ANTHEM INSURANCE COMPANIES, INC. | 103 | $1.1M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 159 | $66K |
| Short-term disability | AFLAC | 30 | $31K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 159 | $66K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 159 | $67K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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.