| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | 202 S MICHIGAN ST SUITE 1400 SOUTH BEND, IN 46601 | ANTHEM INSURANCE COMPANIES, INC. (G2001) | $164 | $0 | $164 | 0.05% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | 202 S MICHIGAN ST SUITE 1400 SOUTH BEND, IN 46601 | PARAMOUNT DENTAL | $3K | $0 | $3K | 10.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 4605 COLUMBUS ST VIRGINIA BEACH, VA 23462 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $320 | $3K | 14.56% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | 202 S MICHIGAN ST SUITE 1400 SOUTH BEND, IN 46601 | ANTHEM LIFE INSURANCE COMPANY (G1400) | $953 | $0 | $953 | 9.18% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 INSURANCE PROVIDER | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Claims processing Service code 12 | — | $117K |
| GIBSON INSURANCE AGENCY INC INSURANCE PROVIDER | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | 333 E JEFFERSON ST PLYMOUTH, IN 46563 | $0 |
| INGENIORX, INC. EIN 82-3062245 INSURANCE PROVIDER | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing; Float revenue Service code 12 | — | -$26K |
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 | 174 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 174 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PARAMOUNT DENTAL | 111 | $33K |
| Vision | ANTHEM INSURANCE COMPANIES, INC. (G2001) | 119 | $309K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY (G1400) | 174 | $10K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 30 | $18K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 30 | $18K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. (G2001) | 119 | $309K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 174 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.