| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | PO BOX 11177 SOUTH BEND, IN 46634 | ANTHEM INSURANCE COMPANIES, INC. (G2001) | $137 | $0 | $137 | 0.06% |
| HEALTH RESOURCES COBRA3 Filed as: HEALTH RESOURCES, INC. | 202 S MICHIGAN ST, STE 1400 SOUTH BEND, IN 46601 | HEALTH RESOURCES, INC. | $3K | $0 | $3K | 10.00% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | PO BOX 11177 SOUTH BEND, IN 46634 | ANTHEM LIFE INSURANCE COMPANY (G1400) | $807 | $0 | $807 | 10.74% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE AGENCY, INC EIN 35-0781558 INSURANCE PROVIDER | Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | 3075 VANDERCAR WAY CINCINNATI, OH 45209 | $63K |
| INGENIORX, INC. EIN 82-3062245 INSURANCE PROVIDER | Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | 3075 VANDERCAR WAY CINCINNATI, OH 45209 | $762 |
| GIBSON INSURANCE AGENCY INC EIN 35-0781558 INSURANCE PROVIDER | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees; Non-monetary compensation Service code 22 | 333 E JEFFERSON ST PLYMOUTH, IN 46563 | $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 | 198 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 198 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | HEALTH RESOURCES, INC. | 110 | $29K |
| Vision | ANTHEM INSURANCE COMPANIES, INC. (G2001) | 114 | $244K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY (G1400) | 159 | $8K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. (G2001) | 114 | $244K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 159 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
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.