| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | 202 S MICHIGAN ST STE 1400 SOUTH BEND, IN 46601 | ALL SAVERS INSURANCE COMPANY | $18K | — | $18K | 5.10% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | PO BOX 11107 FORT WAYNE, IN 468551107 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | $935 | $7K | 11.89% |
| LARRY A DIETZ3 | 50861 FOREST LAKE TRL SOUTH BEND, IN 46628 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 13.69% |
| HORIZON PLANNING GROUP3 | 9000 KEYSTONE CROSSING SUITE 300 INDIANAPOLIS, IN 46240 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $32 | — | $32 | 0.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $47K |
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 | 116 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 119 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 171 | $57K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 171 | $57K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 171 | $90K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 102 | $33K |
| Other(2 contracts, 2 carriers) | ALL SAVERS INSURANCE COMPANY | 102 | $391K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 171 | — |
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.
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.