| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIBSON INSURANCE AGENCY, INC.3 | P.O. BOX 11107 FORT WAYNE, IN 46855 | CIGNA HEALTH AND LIFE INSURANCE COMPANY(CIGNA) | $14K | — | $14K | 9.78% |
| GIBSON INSURANCE AGENCY, INC.3 | PO BOX 11177 SOUTH BEND, IN 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | $6K | $20K | 21.62% |
| FMLASOURCE INC5 | 455 N CITYFRONT PLZ DR 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $9K | $9K | 9.87% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN AND ASSOCIATES LLC | 1933 STATE ROUTE 35 STE 368 WALL TOWNSHIP, NJ 07719 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $5K | $5K | 5.00% |
| GIBSON INSURANCE AGENCY, INC.3 | P.O. BOX 11177 SOUTH BEND, IN 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | $5K | $17K | 21.28% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN AND ASSOCIATES LLC | 1933 STATE ROUTE 35 STE 368 WALL TOWNSHIP, NJ 07719 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 5.00% |
| GIBSON INSURANCE AGENCY, INC.3 | PO BOX 11177 SOUTH BEND, IN 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $5K | $15K | 22.59% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN AND ASSOCIATES LLC | 1933 STATE ROUTE 35 STE 368 WALL TOWNSHIP, NJ 07719 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 5.00% |
| GIBSON INSURANCE AGENCY, INC.3 | PO BOX 11107 FORT WAYNE, IN 46855 | VISION SERVICE PLAN | $2K | — | $2K | 4.07% |
| EMPLOYEE NAVIGATOR, LLC3 | 7979 OLD GEORGETOWN RD STE 300 BETHESDA, MD 208142554 | VISION SERVICE PLAN | $202 | — | $202 | 0.50% |
| GIBSON INSURANCE AGENCY, INC.3 | P.O. BOX 11177 SOUTH BEND, IN 46634 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $755 | $2K | 22.41% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN AND ASSOCIATES LLC | 1933 STATE ROUTE 35 STE 368 WALL TOWNSHIP, NJ 07719 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $509 | $509 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 CLAIMS PROCESSING | Claims processing; Contract Administrator; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $255K |
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 | 386 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 9 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 395 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY(CIGNA) | 387 | $146K |
| Vision | VISION SERVICE PLAN | 328 | $40K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 521 | $102K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 227 | $81K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 152 | $68K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 521 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 521 | — |
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.