| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC. | P.O. BOX 11177 SOUTH BEND, IN 46634 | ANTHEM INSURANCE COMPANIES, INC. | $29K | — | $29K | 2.91% |
| INDIANA CHAMBER INSURANCE AGENCY3 | 115 WEST WASHINGTON STREET SUITE 850S INDIANAPOLIS, IN 46204 | ANTHEM INSURANCE COMPANIES, INC. | $681 | — | $681 | 0.07% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC. | 130 S. MAIN STREET SUITE 400 SOUTH BEND, IN 46601 | HEALTH RESOURCES, INC. | $7K | — | $7K | 10.00% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY | P.O. BOX 11177 SOUTH BEND, IN 46634 | FIDELITY SECURITY INSURANCE COMPANY | $870 | — | $870 | 9.76% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE GROUP | 130 S. MAIN STREET SUITE 400 SOUTH BEND, IN 46601 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $936 | — | $936 | 13.64% |
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 | 137 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 137 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 194 | $1.0M |
| Dental | HEALTH RESOURCES, INC. | 215 | $65K |
| Vision | FIDELITY SECURITY INSURANCE COMPANY | 239 | $9K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 137 | $7K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 137 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 239 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.