| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEYSTONE INSURANCE & BENEFITS GROUP3 Filed as: KEYSTONE INSURANCE & BENEFITS | 13800 JACKSON RD MISHAWAKA, IN 46544 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 7.21% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS | 5025 UTHICA RIDGE RD SUITE 100 DAVENPORT, IA 52807 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | $724 | $5K | 5.19% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MISSOURI LLC | 1441 CHRISTY DRIVE PO BOX 1768 JEFFERSON CITY, MO 65102 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $730 | — | $730 | 0.78% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS GREAT PLAINS LLC | 4200 UNIVERSITY AVE STE 200 WEST DES MOINES, IA 50266 | DEARBORN LIFE INSURANCE COMPANY | $3K | — | $3K | 6.20% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR INC. EIN 39-1995276 CLAIMS PROCESSING | Contract Administrator; Claims processing Service code 12 | — | $291K |
| WINTERS INSURANCE GROUP LLP EIN 81-3867641 BROKER | Other commissions Service code 55 | — | $42K |
| ASSUREDPARTNERS GREAT PLAINS LLC EIN 84-4016035 BROKER | Other commissions Service code 55 | — | $30K |
| ASSUREDPARTNERS OF MISSOURI LLC EIN 80-0948154 BROKER | Other commissions Service code 55 | — | $7K |
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 | 165 | 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) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 165 | $93K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 165 | $93K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 39 | $45K |
| Other | DEARBORN LIFE INSURANCE COMPANY | 39 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 165 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.