| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | STE 400 571 MONON BLVD. CARMEL, IN 46032 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $153K | $34K | $186K | 6.04% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES OF ARIZONA | 2800 N. CENTRAL AVE. STE. 1100 PHOENIX, AZ 85004 | DELTA DENTAL OF ARIZONA | $32K | — | $32K | 4.59% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | SUITE 400 571 MONON BLVD. CARMEL, IN 46032 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $31K | $14K | $45K | 24.13% |
| ASSUREX3 | SUITE 800 175 SOUTH 3RD STREET COLUMBUS, OH 43215 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | — | $6K | 3.20% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS. W. | 16220 N. SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10K | — | $10K | 6.10% |
| MJ INSURANCE3 Filed as: MJ INSURANCE, INC. | 571 MONON BLVD. SUITE 400 CARMEL, IN 46032 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $803 | — | $803 | 0.52% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS. W. | 16220 N. SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | THE PAUL REVERE LIFE INSURANCE COMPANY | $9K | $1K | $10K | 7.74% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | SUITE 400 571 MONON BLVD. CARMEL, IN 46032 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $13K | $2K | $14K | 11.25% |
| HAYS COMPANIES, INC.3 | 80 SO. 8TH ST. STE. 700 MINNEAPOLIS, MN 55402 | DELTA DENTAL OF ARIZONA | $8K | — | $8K | 9.87% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC. | SUITE 400 571 MONON BLVD. CARMEL, IN 46032 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $15K | $6K | $21K | 25.22% |
| ASSUREX3 | SUITE 800 175 SOUTH 3RD STREET COLUMBUS, OH 43215 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 3.33% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS. W. | 16220 N. SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 5.71% |
| MJ INSURANCE3 Filed as: MJ INSURANCE, INC. | 571 MONON BLVD. SUITE 400 CARMEL, IN 46032 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $833 | — | $833 | 1.81% |
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 | 1,018 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,027 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KEPRO | 956 | $39K |
| Dental | DELTA DENTAL OF ARIZONA | 1,608 | $703K |
| Vision | DELTA DENTAL OF ARIZONA | 1,165 | $86K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,914 | $3.1M |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 296 | $128K |
| Long-term disability(7 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,914 | $3.7M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,914 | $3.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,914 | — |
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.