| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | 202 S MICHIGAN STREET, STE 1400 SOUTH BEND, IN 46601 | SYMETRA LIFE INSURANCE COMPANY | $256K | $37K | $293K | 23.80% |
| GIBSON INSURANCE AGENCY, INC.3 | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | DELTA DENTAL OF INDIANA | $36K | $1K | $38K | 10.41% |
| ENROLLEASE3 Filed as: ENROLLEASE, INC D/B/A EASECENTRAL | 1980 FESTIVAL PLAZA DR STE 810 LAS VEGAS, NV 89135 | VISION SERVICE PLAN | $189 | $14K | $14K | 31.43% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NAMIC SERVICE CORPORATION & SUB EIN 35-1176317 NONE | Consulting (general); Direct payment from the plan Service code 16 | 3601 VINCENNES ROAD INDIANAPOLIS, IN 46268 | $232K |
| DOUG JENSEN NONE | Named fiduciary; Direct payment from the plan Service code 31 | 8743 FERRARA COURT NAPLES, FL 341142718 | $25K |
| L.M. HENDERSON & COMPANY, LLP EIN 20-5520612 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 450 E 96TH STREET STE 200 INDIANAPOLIS, IN 46240 | $19K |
| THE SEGAL COMPANY EIN 13-1835864 NONE | Consulting (general); Actuarial; Direct payment from the plan Service code 11 | 30 WATERSIDE DR, STE 300 FARMINGTON, CT 06032 | $18K |
| PNC BANK NA EIN 25-1211909 NONE | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | 249 FIFTH AVE, ONE PNC PL PITTSBURGH, PA 15222 | $18K |
| WILLIS TOWERS WATSON VIA BENEFITS EIN 20-2487260 NONE | Contract Administrator; Direct payment from the plan Service code 13 | 10975 S STERLING VIEW DR SOUTH JORDAN, UT 84095 | $13K |
| ICSO HUMAN RESOURCES ASSOCTN INC. EIN 46-5048228 NONE | Consulting (general); Direct payment from the plan Service code 16 | 3601 VINCENNES ROAD INDIANAPOLIS, IN 46268 | $13K |
| CONNECTYOURCARE FSA EIN 81-0569632 NONE | Direct payment from the plan; Claims processing Service code 12 | 307 INTERNATIONAL CIR HUNT VALLEY, MD 21030 | $8K |
| GREGG DYKSTRA NONE | Legal; Direct payment from the plan Service code 29 | 3601 VINCENNES ROAD INDIANAPOLIS, IN 46268 | $5K |
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 | 581 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 371 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 952 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF INDIANA | 835 | $360K |
| Vision | VISION SERVICE PLAN | 344 | $44K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 880 | $1.2M |
| Short-term disability | SYMETRA LIFE INSURANCE COMPANY | 880 | $1.2M |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 880 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 880 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.