| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIBSON INSURANCE AGENCY, INC.3 | 333 E JEFFERSON ST PLYMOUTH, IN 46563 | ANTHEM LIFE INSURANCE COMPANY (G1400) | $4K | $14 | $4K | 1.78% |
| HEALTH RESOURCES COBRA3 Filed as: HEALTH RESOURCES, INC. | 202 S MICHIGAN ST, STE 1400 SOUTH BEND, IN 46601 | HEALTH RESOURCES, INC. | $2K | — | $2K | 10.00% |
| GIBSON INSURANCE AGENCY, INC.3 | 333 E JEFFERSON ST PLYMOUTH, IN 46563 | ANTHEM LIFE INSURANCE COMPANY (G1400) | $796 | $0 | $796 | 9.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 INSURANCE PROVIDER | Other fees; Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | 3075 VANDERCAR WAY CINCINNATI, OH 45209 | $72K |
| EXPRESS SCRIPTS, INC. EIN 31-1714795 INSURANCE PROVIDER | Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 3075 VANDERCAR WAY CINCINNATI, OH 45209 | $0 |
| GIBSON INSURANCE AGENCY INC EIN 35-1116724 INSURANCE PROVIDER | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 333 E JEFFERSON ST PLYMOUTH, IN 46563 | $0 |
| INGENIORX, INC. EIN 82-3062245 INSURANCE PROVIDER | Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | 3075 VANDERCAR WAY CINCINNATI, OH 45209 | $0 |
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 | 148 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 148 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | HEALTH RESOURCES, INC. | 72 | $21K |
| Vision | ANTHEM LIFE INSURANCE COMPANY (G1400) | 148 | $228K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY (G1400) | 136 | $8K |
| Stop-loss / reinsurancereinsurance | ANTHEM LIFE INSURANCE COMPANY (G1400) | 148 | $228K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 148 | — |
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.