| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JA BENEFITS LLC3 Filed as: JA BENEFITS, LLC | PO BOX 159 BEDFORD, IN 47421 | DELTA DENTAL OF INDIANA | $1K | — | $1K | 2.28% |
| ASSUREDPARTNERS3 Filed as: SHEPHERD INSURANCE LLC | 111 CONGRESSIONAL BOULEVARD SUITE 20 CARMEL, IN 46032 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $433 | $9K | 20.77% |
| KYLE ELLISON3 Filed as: KYLE R ELLISON | 3524 ELMRIDGE DRIVE EVANSVILLE, IN 47711 | AFLAC | $762 | $15 | $777 | 4.34% |
| PATRICIA ANN JONES3 | 917 ALDEN DRIVE FORTVILLE, IN 46040 | AFLAC | $291 | $59 | $350 | 1.95% |
| ROBERT W BURGETT3 | 3670 WEST 141ST STREET CARMEL, IN 46074 | AFLAC | $216 | — | $216 | 1.21% |
| RITA J ABRAM3 | 11500 GOLDEN WILLOW COURT ZIONSVILLE, IN 46077 | AFLAC | $110 | $11 | $121 | 0.68% |
| ASSUREDPARTNERS3 Filed as: SHEPHERD INS LLC | 111 CONGRESSIONAL BOULEVARD SUITE 200 CARMEL, IN 46032 | AFLAC | $82 | — | $82 | 0.46% |
| CANDACE Y HILDEBRAN3 | 1084 KNOLL COURT GREENWOOD, IN 46143 | AFLAC | $51 | $11 | $62 | 0.35% |
| PETER J EMMERT3 | 5904 OAKFORGE LANE INDIANAPOLIS, IN 46254 | AFLAC | $55 | — | $55 | 0.31% |
| BRIANNA LYNN ROWE3 | 3386 CHALICE COURT PLAINFIELD, IN 46168 | AFLAC | $22 | $3 | $25 | 0.14% |
| MICHAEL DUANE ARNOLD3 | 2147 BUTTONBUSH DRIVE PLAINFIELD, IN 46168 | AFLAC | $23 | — | $23 | 0.13% |
| NAVILLE & ASSOCIATES3 | 5511 MOSER KNOB ROAD FLOYDS KNOBS, IN 47119 | AFLAC | $16 | — | $16 | 0.09% |
| DANIEL R HARPER JR3 | 101 WINDSONG COURT GASTONIA, NC 28056 | AFLAC | $8 | — | $8 | 0.04% |
| JENNIFER L MITCHEN3 | 9247 NORTH MERIDIAN STREET SUITE 205 INDIANAPOLIS, IN 46260 | AFLAC | $6 | — | $6 | 0.03% |
| JOHN T CLANCY3 | 4025 PETE DYE BOULEVARD CARMEL, IN 46033 | AFLAC | $6 | — | $6 | 0.03% |
| MARK A WOJDA3 | 16258 DOGWOOD LANE PLYMOUTH, IN 46563 | AFLAC | $6 | — | $6 | 0.03% |
| MATTHEW A COOK3 | 10069 BENT TREE LANE FISHERS, IN 46037 | AFLAC | $6 | — | $6 | 0.03% |
| JA BENEFITS LLC3 Filed as: JA BENEFITS, LLC | PO BOX 159 BEDFORD, IN 47421 | VISION SERVICE PLAN | $629 | — | $629 | 7.79% |
| D'ANN DABELL3 Filed as: D ANN DABELL | 1174 NORTH 2000 EAST LAYTON, UT 84040 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $160 | — | $160 | 13.86% |
| JULIA VON BARGEN3 | 5 GREEN PLACE CARMEL, IN 46033 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $120 | — | $120 | 10.40% |
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 | 145 | 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) | 146 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF INDIANA | 123 | $50K |
| Vision | VISION SERVICE PLAN | 76 | $8K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 119 | $44K |
| Short-term disability | AFLAC | 16 | $18K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 119 | $44K |
| Stop-loss / reinsurancereinsurance | QBE INSURANCE CORPORATION | 76 | $317K |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 119 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 123 | — |
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.