| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE GROUP | PO BOX 11107 FT WAYNE, IN 46855 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $16K | $0 | $16K | 12.63% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE GROUP | PO BOX 11107 FT WAYNE, IN 46855 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $15K | — | $15K | 15.00% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE GROUP | PO BOX 11107 FT WAYNE, IN 46855 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 11.79% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | PO BOX 1087 WAUSAU, WI 54402 | $509K |
| GIBSON INSURANCE AGENCY INC EIN 35-1116724 BROKER | Other commissions Service code 55 | 202 S MICHIGAN ST SUITE 400 SOUTH BEND, IN 46601 | $90K |
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 | 832 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 832 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 832 | $128K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 348 | $97K |
| Other(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 832 | $77K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 832 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.