| 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 | $32K | $36K | $67K | 12.31% |
| NFP INSURANCE SERVICES INC3 Filed as: APEX BENEFITS GROUP INC. | 3755 E 82ND STREET SUITE 100 INDIANAPOLIS, IN 46240 | AMERICAN UNITED LIFE INSURANCE COMPANY | $4K | $671 | $5K | 0.89% |
| WATCH TOWER BENEFITS3 | 227 W. MONROE STREET SUITE 5200 CHICAGO, IL 60606 | AMERICAN UNITED LIFE INSURANCE COMPANY | — | $4K | $4K | 0.71% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY | 202 S MICHIGAN STREET SUITE 1400 SOUTH BEND, IN 46601 | ANTHEM INSURANCE COMPANIES | $6K | — | $6K | 6.85% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | PO BOX 11107 FORT WAYNE, IN 46855 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $9K | $686 | $10K | 13.95% |
| 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 | $2K | — | $2K | 2.48% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP INSURANCE SERVICES | 1250 CAPITAL OF TEXAS HIGHWAY BLDG SUITE 125 AUSTIN, TX 78746 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $508 | $508 | 0.73% |
| PLANSOURCE BENEFIT ADMINISTRATION3 | PO BOX 1313 ORLANDO, FL 32802 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $347 | — | $347 | 0.50% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY | PO BOX 11107 FORT WAYNE, IN 46855 | UNUM LIFE INSURANCE OF AMERICA | $9K | $512 | $9K | 16.61% |
| 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 | $892 | $0 | $892 | 1.58% |
| PLANSOURCE BENEFIT ADMINISTRATION3 Filed as: PLANSOURCE BENEFIT | PO BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE OF AMERICA | $278 | — | $278 | 0.49% |
| NFP INSURANCE SERVICES INC3 Filed as: APEX BENEFITS GROUP INC. | 3755 E 82ND STREET SUITE 100 INDIANAPOLIS, IN 46240 | UNUM LIFE INSURANCE OF AMERICA | $16 | — | $16 | 0.03% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX EIN 33-0441200 PHARMACY BENEFIT MGMT | Float revenue; Claims processing; Other fees; Direct payment from the plan Service code 12 | — | $1.8M |
| UMR INSURANCE COMPANIES EIN 39-1995276 CLAIMS PROCESSOR | Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Insurance agents and brokers; Float revenue; Contract Administrator; Claims processing; Other services Service code 12 | — | $519K |
| COORDINATED CARE PROGRAMS LLC QUANTUM HEALTH, INC. | Other fees; Direct payment from the plan Service code 50 | 44 W 28TH STREET NEW YORK, NY 10001 | $320K |
| BENEFIT TECHNOLOGY RESOURCES, LLC COMPUTER SERVICE | Direct payment from the plan; Other services Service code 49 | 1700 N BROADWAY AVENUE SUITE 116 ROCHESTER, MN 55901 | $61K |
| DELTA DENTAL PLAN OF INDIANA EIN 35-1545647 BENEFIT ADMINISTRATOR | Direct payment from the plan; Other fees Service code 50 | — | $35K |
| EDISON HEALTHCARE COST EFFECTIVE CARE | Other fees; Direct payment from the plan Service code 50 | 100 S. RIVERFRONT DRIVE SUITE 400 JENKS, OK 74037 | $21K |
| RX HELP CENTER, LLC EIN 46-2125122 COST EFFECTIVE CARE | Other fees; Direct payment from the plan Service code 50 | — | $9K |
| BASIC EIN 38-2883561 COBRA ADMIN FEES | Direct payment from the plan; Contract Administrator Service code 13 | — | $6K |
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 | 1,609 | 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) | 1,614 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | ANTHEM INSURANCE COMPANIES | 791 | $85K |
| Life insurance(2 contracts, 2 carriers) | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,342 | $617K |
| Short-term disability(2 contracts, 2 carriers) | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,342 | $617K |
| Long-term disability | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,342 | $547K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 807 | $687K |
| Other(2 contracts, 2 carriers) | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,342 | $604K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,342 | — |
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.