| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CGI - COMMERCIAL GROUP INTERMEDIARI3 Filed as: CGI - COMMERICAL GROUP INTERMEDIARI | 19 ILLINOIS AVE. SCHAUMBURG, IL 60193 | GERBER LIFE | — | $11K | $11K | 5.00% |
| SHAMROCK BENEFITS LLC3 Filed as: SHAMROCK INSURANCE | 3102 N. HOME ST. MISHAWAKA, IN 46545 | GERBER LIFE | $9K | — | $9K | 4.20% |
| SHAMROCK INSURANCE SERVICES3 Filed as: SHAMROCK INSURANCE GROUP | 51593 HIGHLAND SHORES DR GRANGER, IN 46530 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 6.64% |
| SHAMROCK INSURANCE SERVICES3 Filed as: SHAMROCK INSURANCE GROUP, LLC | 3102 N. HOME ST. MISHAWAKA, IN 46545 | RELIANCE MATRIX | $19K | — | $19K | 15.00% |
| MGIS3 | 111 SOUTH MAIN STREET, SUITE 400 SALT LAKE CITY, UT 841112176 | RELIANCE MATRIX | — | $135 | $135 | 0.11% |
| USI INSURANCE SERVICES LLC3 | 307 S MAIN ST. STE 200 ELKHART, IN 46519 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $2K | $8K | 12.07% |
| SHAMROCK INSURANCE SERVICES3 Filed as: SHAMROCK INSURANCE GROUP, LLC | 51593 HIGHLAND SHORES DR GRANGER, IN 46530 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 6.55% |
| SHAMROCK INSURANCE SERVICES3 Filed as: SHAMROCK INSURANCE GROUP, LLC | 51593 HIGHLAND SHORES DR GRANGER, IN 46530 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $327 | — | $327 | — |
| USI INSURANCE SERVICES LLC3 | 307 S MAIN ST. STE 200 ELKHART, IN 46519 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $377 | -$397 | -$20 | — |
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 | 206 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 199 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 406 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 205 | $168K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 205 | $168K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 311 | $0 |
| Long-term disability(2 contracts, 2 carriers) | RELIANCE MATRIX | 311 | $125K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE | 205 | $218K |
| Other(3 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 311 | $233K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 311 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.