| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HYLANT GROUP INC3 | PO BOX 1687 TOLEDO, OH 436031687 | HARTFORD LIFE AND ACCIDENT | $9K | $2K | $11K | 3.05% |
| BENEFIT PLAN ADMINISTRATORS | 402 GRAHAM AVE. P.O. BOX 1128 EAU CLAIRE, WI 547021128 | UNITED STATES FIRE INSURANCE COMPANY | — | $58K | $58K | 24.70% |
| SHAMROCK BENEFITS LLC Filed as: SHAMROCK BENEFITS LIE | 3941 CRYSTAL WATERS LN NE GRAND RAPIDS, MI 49525 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | — | $5K | 4.98% |
| ROSE STREET ADVISORS LLC Filed as: ROSE STREET ADVISORS LIE | 244 NORTH ROSE STREET KALAMAZOO, MI 49007 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 2.37% |
| SUZANNE M CALHOUN | 3104 HADDONSTONE DRIVE OWENS X RD, AL 35763 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $331 | $33 | $364 | 0.39% |
| MARY LOU TAYLOR | 1012 SUGARLOAF RESERVE DR. DULUTH, GA 30097 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $285 | — | $285 | 0.30% |
| TATE ALLEN JESKY | 8169 HUNTING CT GEORGETOWN, MI 49428 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $196 | — | $196 | 0.21% |
| BRANDON TYLER LYNN | 7532 JENISON DRIVE INDIANAPOLIS, IN 46217 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $132 | $1 | $133 | 0.14% |
| MARIA D FLORES LOPEZ | 445 BIG HILL CIRCLE APT D INDIANAPOLIS, IN 46224 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $87 | — | $87 | 0.09% |
| HOWARD HOROWITZ | 2610 ALCOTT STREET CARMEL, IN 46032 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $70 | — | $70 | 0.07% |
| BRUCE A VAN RYN Filed as: BRUCE ALBERT VAN RYN | 3053 RIVERVALE DRIVE GRANDVILLE, MI 49418 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $68 | — | $68 | 0.07% |
| DALE E WASHBURN | 133 POINT SEVEN ROAD KIMBERLING CITY, MO 65686 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | $4 | $51 | 0.05% |
| PARRISH J PEACHEE | 136 NORTH UNION STREET WESTFIELD, IN 46074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | — | $47 | 0.05% |
| DONNIE HILL LLC Filed as: DONNIE HILL LIE | PO BOX 10072 HUNTSVILLE, AL 35801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | $10 | $34 | 0.04% |
| JAMES A SMAARDYK Filed as: JAMES M TAYLOR | 1012 SUGARLOAF RESERVE DR DULUTH, GA 30097 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.03% |
| ROGLE INC | 2116 N. PENNSYLVANIA ST INDIANAPOLIS, IN 46202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | $13 | $26 | 0.03% |
| D'ARCIPRETE & ASSOCIATES INC | 12945 US HIGHWAY 331 MONTGOMERY, AL 36105 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | $14 | $20 | 0.02% |
| TAMARA ANN BUSCHER | 1318 S WINTERBROOK OLATHE, KS 66062 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.02% |
| DALE T BUTLER | 15234 REEDS STREET OVERLAND PARK, KS 66223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.01% |
| BROWN AND BROWN OF FLORIDA, INC. Filed as: MARIA L HERRERA BROWN | 2157 FOX CROSSING LANE FRISCO, TX 75034 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.01% |
| MAUREEN E CONRAN | 8575 WEST 110TH STREET OVERLAND PARK, KS 66210 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.01% |
| LANA L WILHITE LLC Filed as: LANA L WILHITE LIE | 3046 S DELAWARE SPRINGFIELD, MO 65804 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $1 | $9 | 0.01% |
| RALPH E ZIMMERMAN | 248 E MONASTERY ST #237 SPRINGFIELD, MO 65810 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.01% |
| TGL ASSOCIATES LLC | 3046 SOUTH DELAWARE SPRINGFIELD, MO 65804 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | $1 | $7 | 0.01% |
| WILLIAM NEAL SCHUMAKER | PO BOX 989 NIXA, MO 65714 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.01% |
| TERRY ALLEN SMITH | 14070 S DARNELL CT OLATHE, KS 66062 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| MARILYN B BOWLING | 19204 WEST 102ND ST LENEXA, KS 66220 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.00% |
| DENNIS W BYERS | 8739 PROMONTORY RD INDIANAPOLIS, IN 46236 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.00% |
| ERIC W MULFORD | 2305 ANDREW JACKSON WAY NE HUNTSVILLE, AL 35811 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| AMWINS5 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | MONUMENTAL LIFE INSURANCE CO. MEDICARE SUPPLEMENT | $6K | — | $6K | 14.12% |
| HYLANT GROUP INC3 | 811 MADISON AVENUE TOLEDO, OH 43604 | MONUMENTAL LIFE INSURANCE CO. MEDICARE SUPPLEMENT | $2K | — | $2K | 3.53% |
| AMWINS5 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | STONEBRIDGE LIFE INSURANCE MEDICARE GENERATION RX (EMPLOYER PDP) | $4K | — | $4K | 10.00% |
| HYLANT GROUP INC3 | 811 MADISON AVENUE TOLEDO, OH 43604 | STONEBRIDGE LIFE INSURANCE MEDICARE GENERATION RX (EMPLOYER PDP) | $482 | — | $482 | 1.11% |
| SHAMROCK BENEFITS LLC | 3941 CRYSTAL WATERS LN NE GRAND RAPIDS, MI 49525 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $873 | — | $873 | 4.02% |
| ROSE STREET ADVISORS LLC | 244 NORTH ROSE STREET KALAMAZOO, MI 49007 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $368 | — | $368 | 1.70% |
| MARY LOU TAYLOR | 1012 SUGARLOAF RESERVE DR. DULUTH, GA 30097 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $111 | — | $111 | 0.51% |
| SUZANNE M CALHOUN | 3104 HADDONSTONE DRIVE OWENS X RD, AL 35763 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $55 | — | $55 | 0.25% |
| HOWARD HOROWITZ | 2610 ALCOTT STREET CARMEL, IN 46032 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 0.11% |
| DALE E WASHBURN | 133 POINT SEVEN ROAD KIMBERLING CITY, MO 65686 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $1 | $13 | 0.06% |
| TATE ALLEN JESKY | 8169 HUNTING CT GEORGETOWN, MI 49428 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.06% |
| BRANDON TYLER LYNN | 7532 JENISON DRIVE INDIANAPOLIS, IN 46217 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.06% |
| BRUCE A VAN RYN Filed as: BRUCE ALBERT VAN RYN | 3053 RIVERVALE DRIVE GRANDVILLE, MI 49418 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.05% |
| C&J BENEFITS AGENCY LLC | 123 HILLTOP BUSINESS DRIVE PELHAM, AL 35124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.04% |
| JAMES A SMAARDYK Filed as: JAMES M TAYLOR | 1012 SUGARLOAF RESERVE DR. DULUTH, GA 30097 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.04% |
| TAMARA ANN BUSCHER | 1318 S WINTERBROOK OLATHE, KS 66062 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.03% |
| JT BENEFITS LLC | 123 HILLTOP BUSINESS CENTER DR PELHAM, AL 35124 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.02% |
| MARIA D FLORES LOPEZ | 445 BIG HILL CIRCLE APT D INDIANAPOLIS, IN 46224 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.02% |
| TERRY ALLEN SMITH | 14070 S DARNELL CT OLATHE, KS 66062 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| RALPH E ZIMMERMAN | 248 E MONASTERY ST #237 SPRINGFIELD, MO 65810 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| BROWN AND BROWN OF FLORIDA, INC. Filed as: MARIA L HERRERA BROWN | 2157 FOX CROSSING LANE FRISCO, TX 75034 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| ROGLE INC | 2116 N. PENNSYLVANIA ST INDIANAPOLIS, IN 46202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.01% |
| WILLIAM NEAL SCHUMAKER | PO BOX 989 NIXA, MO 65714 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| LANA L WILHITE LLC | 3046 S DELAWARE SPRINGFIELD, MO 65804 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| ERIC W MULFORD | 2305 ANDREW JACKSON WAY NE HUNTSVILLE, AL 35811 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| MAUREEN E CONRAN | 8575 WEST 110TH STREET OVERLAND PARK, KS 66210 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| MARILYN B BOWLING | 19204 WEST 102ND ST LENEXA, KS 66220 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| TGL ASSOCIATES LLC | 3046 SOUTH DELAWARE SPRINGFIELD, MO 65804 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| PARRISH J PEACHEE | 201 W 103RD ST INDIANAPOLIS, IN 46290 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $628K |
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 | 1,081 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,081 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MONUMENTAL LIFE INSURANCE CO. MEDICARE SUPPLEMENT | 22 | $45K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 424 | $178K |
| Vision(2 contracts) | EYEMED | 1,081 | $97K |
| Life insurance(5 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 816 | $605K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 259 | $82K |
| Long-term disability(3 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 816 | $419K |
| Prescription drug | STONEBRIDGE LIFE INSURANCE MEDICARE GENERATION RX (EMPLOYER PDP) | 22 | $43K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | PARTNERRE AMERICA INSURANCE COMPANY (PRAIC) | 640 | $772K |
| Other(7 contracts, 4 carriers) | HARTFORD LIFE AND ACCIDENT | 816 | $555K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,081 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.