| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY | PO BOX 11177 SOUTH BEND, IN 46634 | AMERICAN UNITED LIFE INSURANCE COMPANY | $30K | $7K | $37K | 7.19% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY | PO BOX 11177 SOUTH BEND, IN 46634 | ANTHEM INSURANCE COMPANIES | $9K | $197 | $9K | 9.03% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | PO BOX 610 PLYMOUTH, IN 46563 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $545 | $7K | 9.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-ATLANTIC INC. | 9713 KEY WEST AVENUE SUITE 401 ROCKVILLE, MD 20874 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $203 | $7K | 9.34% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP INSURANCE SERVICES | 1250 CAPITAL OF TX HWY #2 AUSTIN, TX 78746 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $404 | $404 | 0.56% |
| PLANSOURCE BENEFIT ADMINISTRATION3 | PO BOX 1313 ORLANDO, FL 32802 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $339 | — | $339 | 0.47% |
| BENEFIT ADVISORS NETWORK LLC3 Filed as: BENEFIT ADVISORS NETWORK | 6830 COCHRAN ROAD SOLON, OH 44139 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $203 | $203 | 0.28% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY | PO BOX 610 333 E. JEFFERSON PLYMOUTH, IN 46563 | UNUM LIFE INSURANCE OF AMERICA | $8K | $459 | $8K | 13.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-ATLANTIC INC. | 9713 KEY WEST AVENUE SUITE 401 ROCKVILLE, MD 20874 | UNUM LIFE INSURANCE OF AMERICA | $5K | $188 | $5K | 8.99% |
| PLANSOURCE BENEFIT ADMINISTRATION3 Filed as: PLANSOURCE BENEFIT | PO BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE OF AMERICA | $280 | — | $280 | 0.46% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX EIN 33-0441200 PHARMACY BENEFIT MGMT | Claims processing; Float revenue; Other fees; Direct payment from the plan Service code 12 | — | $1.6M |
| UMR INSURANCE COMPANIES EIN 39-1995276 CLAIMS PROCESSOR | Claims processing; Other services; Other fees; Contract Administrator; Insurance agents and brokers; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $507K |
| COORDINATED CARE PROGRAMS LLC QUANTUM HEALTH, INC. | Direct payment from the plan; Other fees Service code 50 | 44 W 28TH STREET NEW YORK, NY 10001 | $312K |
| BENEFIT TECHNOLOGY RESOURCES, LLC COMPUTER SERVICE | Other services; Direct payment from the plan Service code 49 | 1700 N BROADWAY AVENUE SUITE 116 ROCHESTER, MN 55901 | $53K |
| EDISON HEALTHCARE COST EFFECTIVE CARE | Other fees; Direct payment from the plan Service code 50 | 100 S. RIVERFRONT DRIVE SUITE 400 JENKS, OK 74037 | $44K |
| DELTA DENTAL EIN 35-1545647 BENEFIT ADMINISTRATOR | Other fees; Direct payment from the plan Service code 50 | — | $36K |
| ANTHEM INSURANCE COMPANIES EIN 35-0781558 CLAIMS PROCESSOR | Other fees; Insurance agents and brokers; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing Service code 12 | — | $13K |
| BASIC EIN 38-2883561 COBRA ADMIN FEES | Direct payment from the plan; Contract Administrator Service code 13 | — | $10K |
| RX HELP CENTER, LLC EIN 46-2125122 COST EFFECTIVE CARE | Direct payment from the plan; Other fees Service code 50 | — | $9K |
| ANTHEM INSURANCE COMPANIES, INC. | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Float revenue; Contract Administrator Service code 12 | — | $0 |
| GIBSON INSURANCE AGENCY INC. | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | — | $0 |
| INSURANCE EXCHANGE, INC. | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $0 |
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 | 1,577 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,582 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | ANTHEM INSURANCE COMPANIES | 724 | $97K |
| Life insurance(2 contracts, 2 carriers) | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,225 | $583K |
| Short-term disability(2 contracts, 2 carriers) | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,225 | $583K |
| Long-term disability | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,225 | $511K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 815 | $639K |
| Other(2 contracts, 2 carriers) | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,225 | $571K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,225 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.