| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 | PO BOX 3430 CARMEL, IN 46082 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $6K | $0 | $6K | 0.29% |
| MJ INSURANCE3 | 3900 EAST CAMELBACK ROAD, SUITE 225 PHOENIX, AZ 85018 | LIFE INSURANCE COMPANY OF AMERICA | $63K | $0 | $63K | 9.97% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R. NELLIGAN & ASSOCIATES, LLC | 1933 STATE ROUTE 35 WALL, NJ 07719 | LIFE INSURANCE COMPANY OF AMERICA | $0 | $19K | $19K | 3.00% |
| MJ INSURANCE3 | PO BOX 3430 CARMEL, IN 46082 | LIFE INSURANCE COMPANY OF AMERICA | $0 | $13K | $13K | 2.08% |
| MJ INSURANCE3 | 571 MONON BOULEVARD, SUITE 400 CARMEL, IN 46032 | UNUM INSURANCE COMPANY | $20K | $2K | $22K | 20.31% |
| MJ INSURANCE3 | 3900 EAST CAMELBACK ROAD, SUITE 225 PHOENIX, AZ 85018 | DELTA DENTAL OF ARIZONA | $11K | $0 | $11K | 10.77% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 16220 NORTH SCOTTSDALE ROAD SUITE 600 SCOTTSDALE, AZ 85254 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $820 | $0 | $820 | 82.41% |
| BUSINESSOLVER.COM, INC.3 Filed as: BUSINESSOLVER, INC. | 1025 ASHWORTH ROAD, SUITE 101 WEST DES MOINES, IA 50265 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $280 | $0 | $280 | 28.14% |
| MJ INSURANCE3 | 571 MONON BOULEVARD, SUITE 400 CARMEL, IN 46032 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $102 | $32 | $134 | 13.47% |
| ASSUREX GLOBAL CORPORATION3 | 6620 MOONEY STREET, SUITE 360 DUBLIN, OH 43017 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $27 | $27 | 2.71% |
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 | 1,496 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,503 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,189 | $2.1M |
| Vision | DELTA DENTAL OF ARIZONA | 2,391 | $98K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF AMERICA | 1,496 | $636K |
| Short-term disability | LIFE INSURANCE COMPANY OF AMERICA | 1,496 | $635K |
| Long-term disability | LIFE INSURANCE COMPANY OF AMERICA | 1,496 | $635K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF AMERICA | 1,496 | $745K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,391 | — |
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."
No prospect flags tripped on this filing.