| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY | PO BOX 610, 333 E. JEFFERSON PLYMOUTH, IN 46563 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $20 | $5K | 5.78% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY | 202 S MICHIGAN ST, STE 1400 SOUTH BEND, IN 46601 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $20 | $4K | 4.53% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY | PO BOX 610, 333 E. JEFFERSON PLYMOUTH, IN 46563 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 15.75% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY | PO BOX 610, 333 E. JEFFERSON PLYMOUTH, IN 46563 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 15.75% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY | PO BOX 11177 SOUTH BEND, IN 46634 | EYEMED VISION CARE | $2K | — | $2K | 10.32% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PHARMACY MANAGEMNT | Float revenue; Other fees; Claims processing; Direct payment from the plan Service code 12 | — | $204K |
| UMR INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $71K |
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 | 232 | 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) | 232 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 172 | $93K |
| Vision | EYEMED VISION CARE | 205 | $19K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 150 | $31K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 51 | $27K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 150 | $31K |
| Stop-loss / reinsurancereinsurance | CRUM & FORSTER | 134 | $355K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 150 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 205 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.