| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | 11801 N TATUM BLVD STE 124 PHOENIX, AZ 85028 | SYMETRA LIFE INSURANCE COMPANY | $199K | $51K | $250K | 23.39% |
| GIBSON INSURANCE AGENCY, INC.3 | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | DELTA DENTAL OF INDIANA | $35K | — | $35K | 9.13% |
| GIBSON INSURANCE AGENCY, INC.3 | 202 S MICHIGAN ST STE 1400 SOUTH BEND, IN 46601 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $22K | — | $22K | 23.49% |
| GIBSON INSURANCE AGENCY, INC.3 | 202 S MICHIGAN ST STE 1400 SOUTH BEND, IN 46601 | VISION SERVICE PLAN | — | $12K | $12K | 18.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NAMIC INSURANCE AGENCY EIN 35-1469772 NONE | Direct payment from the plan; Consulting (general) Service code 16 | 3601 VINCENNES ROAD INDIANAPOLIS, IN 46268 | $229K |
| PNC BANK NA EIN 22-1146430 NONE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | 1900 E. 9TH STREET 8TH FL CLEVELAND, OH 44114 | $24K |
| L.M. HENDERSON & COMPANY, LLP EIN 20-5520612 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | 450 E 96TH STREET STE 200 INDIANAPOLIS, IN 46240 | $22K |
| RON CASSESSO NONE | Direct payment from the plan; Named fiduciary Service code 31 | 3601 VINCENNES ROAD INDIANAPOLIS, IN 46268 | $20K |
| THE SEGAL COMPANY EIN 13-1835864 NONE | Direct payment from the plan; Actuarial; Consulting (general) Service code 11 | 30 WATERSIDE DR, STE 300 FARMINGTON, CT 06032 | $19K |
| EXTEND HEALTH, INC NONE | Direct payment from the plan; Consulting (general) Service code 16 | 38 EAST SCENIC POINTE DR DRAPER, UT 84020 | $16K |
| 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 | $14K |
| CLARITY BENEFIT SOLUTIONS FSA NONE | Direct payment from the plan; Consulting (general) Service code 16 | 90 WOODBRIDGE CENTER DR. WOODBRIDGE, NJ 07095 | $11K |
| IRON MOUNTAIN NONE | Direct payment from the plan; Recordkeeping fees Service code 50 | — | $10K |
| BOARDMAN & CLARK EIN 45-3866466 NONE | Legal; Direct payment from the plan Service code 29 | 15 PINCKNEY ST STE 410 MADISON, WI 537010927 | $9K |
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 | 745 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 457 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,202 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF INDIANA | 915 | $380K |
| Vision | VISION SERVICE PLAN | 466 | $65K |
| Life insurance(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 1,771 | $1.2M |
| Short-term disability | SYMETRA LIFE INSURANCE COMPANY | 1,771 | $1.1M |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 1,771 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,771 | — |
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.