| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEYSTONE INSURANCE & BENEFITS GROUP3 Filed as: KEYSTONE INSURANCE AND BENEFITS GRO | 13800 JACKSON RD MISHAWAKA, IN 46544 | ANTHEM INSURANCE COMPANIES, INC. | $20K | — | $20K | 3.81% |
| INDIANA CHAMBER INSURANCE AGENCY IN3 | 115 WEST WASHINGTON ST SUITE 850S INDIANAPOLIS, IN 46204 | ANTHEM INSURANCE COMPANIES, INC. | $488 | — | $488 | 0.09% |
| KEYSTONE INSURANCE & BENEFITS GROUP3 Filed as: KEYSTONE INSURANCE AND BENEFITS GRO | 13800 JACKSON RD MISHAWAKA, IN 46544 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | $739 | $5K | 12.41% |
| STEPHAN SCEROLER3 | 377 HIGHWAY 21 SUITE 100 MADINSVILLE, LA 70447 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $59 | $1K | 21.03% |
| KEYSTONE INSURANCE & BENEFITS GROUP3 Filed as: KEYSTONE INSURANCE AND BENEFITS GRO | 13800 JACKSON RD MISHAWAKA, IN 46544 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $289 | — | $289 | 5.00% |
| FORESTER BENEFITS MANAGEMENT LLC3 | 1909 PINNACLE POINTE WAY KNOXVILLE, TN 37922 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $289 | — | $289 | 5.00% |
| STEPHAN SCEROLER3 | 377 HIGHWAY 21 SUITE 100 MADINSVILLE, LA 70447 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $549 | $25 | $574 | 15.69% |
| KEYSTONE INSURANCE & BENEFITS GROUP3 Filed as: KEYSTONE INSURANCE AND BENEFITS GRO | 13800 JACKSON RD MISHAWAKA, IN 46544 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $183 | — | $183 | 5.00% |
| FORESTER BENEFITS MANAGEMENT LLC3 | 1909 PINNACLE POINTE WAY KNOXVILLE, TN 37922 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $183 | — | $183 | 5.00% |
| STEPHAN SCEROLER3 | 377 HIGHWAY 21 SUITE 100 MADINSVILLE, LA 70447 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $643 | $38 | $681 | 21.18% |
| KEYSTONE INSURANCE & BENEFITS GROUP3 Filed as: KEYSTONE INSURANCE AND BENEFITS GRO | 13800 JACKSON RD MISHAWAKA, IN 46544 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $161 | — | $161 | 5.01% |
| FORESTER BENEFITS MANAGEMENT LLC3 | 1909 PINNACLE POINTE WAY KNOXVILLE, TN 37922 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $161 | — | $161 | 5.01% |
| KEYSTONE INSURANCE & BENEFITS GROUP3 Filed as: KEYSTONE INSURANCE AND BENEFITS GRO | 13800 JACKSON RD MISHAWAKA, IN 46544 | ANTHEM LIFE INSURANCE COMPANY | $252 | — | $252 | 7.93% |
| STEPHAN SCEROLER3 | 377 HIGHWAY 21 SUITE 100 MADINSVILLE, LA 70447 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $562 | $44 | $606 | 21.68% |
| KEYSTONE INSURANCE & BENEFITS GROUP3 Filed as: KEYSTONE INSURANCE AND BENEFITS GRO | 13800 JACKSON RD MISHAWAKA, IN 46544 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $277 | — | $277 | 9.91% |
| FORESTER BENEFITS MANAGEMENT LLC3 | 1909 PINNACLE POINTE WAY KNOXVILLE, TN 37922 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $140 | — | $140 | 5.01% |
| STEPHAN SCEROLER3 | 377 HIGHWAY 21 SUITE 100 MADINSVILLE, LA 70447 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $371 | $17 | $388 | 15.68% |
| KEYSTONE INSURANCE & BENEFITS GROUP3 Filed as: KEYSTONE INSURANCE AND BENEFITS GRO | 13800 JACKSON RD MISHAWAKA, IN 46544 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $124 | — | $124 | 5.01% |
| FORESTER BENEFITS MANAGEMENT LLC3 | 1909 PINNACLE POINTE WAY KNOXVILLE, TN 37922 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $124 | — | $124 | 5.01% |
| STEPHAN SCEROLER3 | 377 HIGHWAY 21 SUITE 100 MADINSVILLE, LA 70447 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $119 | $7 | $126 | 21.21% |
| KEYSTONE INSURANCE & BENEFITS GROUP3 Filed as: KEYSTONE INSURANCE AND BENEFITS GRO | 13800 JACKSON RD MISHAWAKA, IN 46544 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $59 | — | $59 | 9.93% |
| FORESTER BENEFITS MANAGEMENT LLC3 | 1909 PINNACLE POINTE WAY KNOXVILLE, TN 37922 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $30 | — | $30 | 5.05% |
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 | 298 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 298 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 81 | $529K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 87 | $37K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 87 | $37K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 46 | $3K |
| Other(7 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 298 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 298 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.