| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RONALD F REMAK INSURANCE INC3 | 306 SOUTH STATE ROAD 446 BLOOMINGTON, IN 47401 | UNITEDHEALTHCARE INSURANCE COMPANY | $24K | — | $24K | 3.12% |
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 10 NORTH PARK DRIVE SUITE 200 HUNT VALLEY, MD 21030 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $119 | $119 | 0.02% |
| CATHY A SCRIVNER3 | 4238 ROYAL OAK DRIVE NEW ALBANY, IN 47150 | PRE-PAID LEGAL SERVICES INC DBA LEAGALSHIELD | $179 | — | $179 | 7.56% |
| LARRY J LYNN3 | 8614 COUNTY ROAD 403 CHARLESTOWN, IN 47111 | PRE-PAID LEGAL SERVICES INC DBA LEAGALSHIELD | $172 | — | $172 | 7.26% |
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 | 107 | 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) | 107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 203 | $771K |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 203 | $771K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 203 | $771K |
| Life insurance | UNITEDHEALTHCARE INSURANCE COMPANY | 203 | $771K |
| Other(3 contracts, 3 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 203 | $776K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 203 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.