| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GIBSON INSURANCE AGENCY, INC.3 | 202 S MICHIGAN ST STE 1400 SOUTH BEND, IN 466012020 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $10K | — | $10K | 8.75% |
| HUNTINGTON INSURANCE INC3 Filed as: HUNTINGTON INSURANCE, INC. | 37 W BROAD ST COLUMBUS, OH 43215 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $7K | — | $7K | 6.25% |
| GIBSON INSURANCE AGENCY, INC.3 | 202 S MICHIGAN ST STE 1400 SOUTH BEND, IN 466012020 | THE LINCOLN NATIONAL LIFE COMPANY | $7K | — | $7K | 8.62% |
| HUNTINGTON INSURANCE INC3 Filed as: HUNTINGTON INSURANCE, INC. | 37 W BROAD STREET COLUMBUS, OH 43215 | THE LINCOLN NATIONAL LIFE COMPANY | $5K | — | $5K | 6.38% |
| HUNTINGTON INSURANCE INC3 Filed as: HUNTINGTON INSURANCE, INC | 221 S CHURCH ST BOWLING GREEN, OH 43402 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INS CO | $2K | — | $2K | 5.96% |
| GIBSON INSURANCE AGENCY, INC.3 | 202 S MICHIGAN STREET STE 1400 SOUTH BEND, IN 466012020 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 8.61% |
| HUNTINGTON INSURANCE INC3 Filed as: HUNTINGTON INSURANCE, INC. | 37 W BROAD STREET COLUMBUS, OH 43215 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 6.39% |
| ROGLE INC3 Filed as: ROGLE, INC. | 7460 LANTERN ROAD INIANAPOLIS, IN 46256 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $3K | $6K | 36.56% |
| PAULETTE VICTORIA WALKER3 | 1425 PARK PLACE BROOKLYN, NY 12213 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $356 | $2K | $2K | 15.24% |
| HUNTINGTON INSURANCE - MILLERSBURG3 Filed as: HUNINGTON INSURANCE, INC. | 221 SOUTH CHURCH STREET BOWLING GREEN, OH 43402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 10.47% |
| ROBERT W BURGETT3 Filed as: ROBERT DOERR | 16844 BURKET CT WESTFIELD, IN 46074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $811 | $187 | $998 | 6.50% |
| GIBSON INSURANCE AGENCY, INC.3 | 202 S MICHIGAN ST STE 1400 SOUTH BEND, IN 46601 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $584 | $412 | $996 | 6.48% |
| KAMI L STANLEY3 | 3303 S 79TH ST LINCOLN, NE 68506 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $432 | $376 | $808 | 5.26% |
| CHARITY DAWN MEARS3 | 5859 N MERIDIAN STREET INIANAPOLIS, IN 46208 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $321 | $167 | $488 | 3.18% |
| SOTERIA PARTNERS LLC3 | 8 SPRUCE STREET NEW YORK, NY 10038 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $31 | $58 | 0.38% |
| ENROLLEASE3 Filed as: JACQUELINE E FORBES-CLARKE | 27 HUDSON AVENUE MT VERNON, NY 10553 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.18% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRUE RX MANAGEMENT SERVICES, INC. EIN 26-0502364 PBM | Claims processing Service code 12 | — | $293K |
| DELTA DENTAL OF INDIANA EIN 35-1545647 BENEFIT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $12K |
| LINCON NATIONAL LIFE INSURANCE COMP EIN 35-0472300 INSURANCE BROKER | Claims processing Service code 12 | — | $7K |
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 | 288 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 288 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INS CO | 662 | $33K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 278 | $31K |
| Long-term disability | THE LINCOLN NATIONAL LIFE COMPANY | 278 | $86K |
| Other(3 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 278 | $158K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 662 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.