| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN RISK MANAGEMENT, LLC3 Filed as: R & R BENEFITS RISK MANAGEMENT LLC | 1251 N EDDY ST STE 201 SOUTH BEND, IN 46617 | SIRIUS AMERICAN INSURANCE CO | — | $20K | $20K | 13.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1251 N EDDY ST STE 201 SOUTH BEND, IN 46617 | SIRIUS AMERICAN INSURANCE CO | — | $15K | $15K | 9.55% |
| AUXIANT3 | 2450 RIMROCK RD MADISON, WI 53713 | SIRIUS AMERICAN INSURANCE CO | $14K | — | $14K | 9.16% |
| TIMOTHY GUY HICKS3 | 509 W 6TH ST MILFORD, IN 46542 | AFLAC | $10K | — | $10K | 19.33% |
| LAYNE FINANCIAL INC3 Filed as: LAYNE LEEPER | 707 ASTER CT BOURBON, IN 46504 | AFLAC | $2K | — | $2K | 4.77% |
| STEPHANIE BEDIENT3 | 10570 BROOKSTON DR E OSCEOLA, IN 46561 | AFLAC | $2K | $86 | $2K | 3.58% |
| JONATHAN DAVID BESWARICK3 | 220 INSURANCE DR FORT WAYNE, IN 46825 | AFLAC | $2K | — | $2K | 3.14% |
| ENRIQUE BARRANCO PEREZ3 | 58915 BREMEN HWY MISHAWAKA, IN 46544 | AFLAC | $649 | — | $649 | 1.28% |
| JONATHAN DAVID BESWARICK3 | 250 ESTATES DR GIBSONIA, PA 15044 | AFLAC | $294 | — | $294 | 0.58% |
| JOHN FRANCIS DYER3 | 315 RUNAWAY BAY CIR APT 3A MISHAWAKA, IN 46545 | AFLAC | $120 | — | $120 | 0.24% |
| STEPHANIE BEDIENT3 | 10570 BROOKSTON DR E OSCEOLA, IN 46561 | AFLAC | $4K | $601 | $5K | 14.25% |
| TIMOTHY GUY HICKS3 | 509 W 6TH ST MILFORD, IN 46542 | AFLAC | $3K | $66 | $3K | 8.18% |
| MICHAEL MARK BERARDINO3 | 1124 WOODWARD AVE SOUTH BEND, IN 46616 | AFLAC | $724 | — | $724 | 2.27% |
| JONATHAN DAVID BESWARICK3 | 220 INSURANCE DR FORT WAYNE, IN 46825 | AFLAC | $666 | — | $666 | 2.09% |
| ANTHONY W MOORE3 | 10242 MULBERRY LN GRANGER, IN 46530 | AFLAC | $493 | — | $493 | 1.55% |
| JONATHAN DAVID BESWARICK3 | 250 ESTATES DR GIBSONIA, PA 15044 | AFLAC | $279 | $66 | $345 | 1.08% |
| ALICIA NICOLE THORN3 | 9251 E SLEEPY HOLLOW PKWY CROMWELL, IN 46732 | AFLAC | $282 | $26 | $308 | 0.97% |
| JUDITH STEWART3 | 235 IRONWORKS AVE APT 218 MISHAWAKA, IN 46544 | AFLAC | $254 | — | $254 | 0.80% |
| JASON MICHAEL RICE3 | 52173 PINEDALE CT GRANGER, IN 46530 | AFLAC | $184 | — | $184 | 0.58% |
| PAUL M MARTINDALE3 | 10255 PRETTY LAKE TRL PLYMOUTH, IN 46563 | AFLAC | $167 | — | $167 | 0.52% |
| TORREY A AMSTUTZ3 | 1125 E LAKEWOOD ST SPRINGFIELD, MO 65810 | AFLAC | $61 | — | $61 | 0.19% |
| DAVID R KREMER3 | 2150 ASSOCIATION DR STE 150 OKEMOS, MI 48864 | AFLAC | $47 | — | $47 | 0.15% |
| BERN MCGRANE3 | 4380 3RD RD BREMEN, IN 46506 | AFLAC | $44 | — | $44 | 0.14% |
| LAYNE FINANCIAL INC3 Filed as: LAYNE LEEPER | 707 ASTER CT BOURBON, IN 46504 | AFLAC | $38 | — | $38 | 0.12% |
| CAROL J THOMPSON3 | 51717 SUMMER WOOD CT GRANGER, IN 46530 | AFLAC | $33 | — | $33 | 0.10% |
| JERAD C CROOKS3 | 540 S MAIN ST BOURBON, IN 46504 | AFLAC | $26 | — | $26 | 0.08% |
| AMY L BEER3 | 72067 COUNTY ROAD 19 MILFORD, IN 46542 | AFLAC | $25 | — | $25 | 0.08% |
| CURTIS A BRUGH II3 | 10515 SUGAR RIDGE WAY INDIANAPOLIS, IN 46239 | AFLAC | $24 | — | $24 | 0.08% |
| JOHN F GLAUB3 | 54369 30TH ST SOUTH BEND, IN 46635 | AFLAC | $12 | — | $12 | 0.04% |
| DOUGLAS E FOX3 | 6836 THAYER LAKE DR ALDEN, MI 49612 | AFLAC | $8 | — | $8 | 0.03% |
| MATTHEW M NACHAZEL3 | 16473 BAYWOOD LN GRANGER, IN 46530 | AFLAC | $8 | — | $8 | 0.03% |
| TIMOTHY B ASBY3 | 9247 N MERIDIAN ST STE 205 INDIANAPOLIS, IN 46260 | AFLAC | $6 | — | $6 | 0.02% |
| NAVILLE & ASSOCIATES3 | 5511 MOSER KNOB RD FLOYDS KNOBS, IN 47119 | AFLAC | $6 | — | $6 | 0.02% |
| MATTHEW A COOK3 | 10069 BENT TREE LN FISHERS, IN 46037 | AFLAC | $4 | — | $4 | 0.01% |
| CARRIE C SCHRAMM3 | 10418 PRETTY LAKE TRL PLYMOUTH, IN 46563 | AFLAC | $3 | — | $3 | 0.01% |
| JOHN T CLANCY3 | 4025 PETE DYE BLVD CARMEL, IN 46033 | AFLAC | $2 | — | $2 | 0.01% |
| MARK A WOJDA3 | 16258 DOGWOOD LN PLYMOUTH, IN 46563 | AFLAC | $2 | — | $2 | 0.01% |
| KEVIN F WARD3 | 12632 DOUBLE EAGLE DR CARMEL, IN 46033 | AFLAC | $2 | — | $2 | 0.01% |
| BRIANNA LYNN ROWE3 | 3386 CHALICE CT PLAINFIELD, IN 46168 | AFLAC | $2 | — | $2 | 0.01% |
| KATIE J FLETCHER3 | 21263 STATE HIGHWAY 148 MARYVILLE, MO 64468 | AFLAC | $1 | — | $1 | 0.00% |
| AMY N GEHLHAUSEN3 | 3115 HOWARD DR JASPER, IN 47546 | AFLAC | $1 | — | $1 | 0.00% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: R & R BENEFITS RISK MANAGEMENT LLC | 1251 N EDDY ST STE 200 SOUTH BEND, IN 46617 | PARAMOUNT DENTAL | $2K | — | $2K | 5.82% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | PARAMOUNT DENTAL | $1K | — | $1K | 4.18% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: R & R BENEFITS RISK MANAGEMENT LLC | 1251 N EDDY ST STE 200 SOUTH BEND, IN 46617 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 10.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | METROPOLITAN LIFE INSURANCE COMPANY | $763 | $54 | $817 | 3.05% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: R & R BENEFITS RISK MANAGEMENT LLC | 1251 N EDDY ST STE 200 SOUTH BEND, IN 46617 | PARAMOUNT DENTAL | $1K | — | $1K | 5.83% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | PARAMOUNT DENTAL | $898 | — | $898 | 4.17% |
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 | 155 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 157 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SIRIUS AMERICAN INSURANCE CO | 103 | $158K |
| Dental(2 contracts) | PARAMOUNT DENTAL | 99 | $50K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 275 | $27K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 275 | $27K |
| Short-term disability(2 contracts) | AFLAC | 54 | $82K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 275 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 275 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.