| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PLATINUM BENEFIT CONSULTING GROUP3 | 4215 EDISON LAKES PARKWAY STE 200 MISHAWAKA, IN 46545 | ANTHEM INSURANCE COMPANIES, INC. (G2001) | $27K | $392 | $27K | 3.29% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | PO BOX 11177 SOUTH BEND, IN 46634 | ANTHEM INSURANCE COMPANIES, INC. (G2001) | $2K | — | $2K | 0.25% |
| PLATINUM BENEFIT CONSULTING GROUP3 Filed as: PLATINUM BENEFIT CONSULTING GR | 4215 EDISON LAKES PKWY SUITE 200 MISHAWAKA, IN 46545 | GUARDIAN | $7K | $483 | $8K | 11.38% |
| PLATINUM BENEFIT CONSULTING GROUP3 | 4215 EDISON LAKES PARKWAY STE 200 MISHAWAKA, IN 46545 | HEALTH RESOURCES, INC. | $5K | — | $5K | 9.87% |
| PLATINUM BENEFIT CONSULTING GROUP3 | 4215 EDISON LAKES PARKWAY SUITE 200 MISHAWAKA, IN 46545 | ANTHEM LIFE INSURANCE COMPANY (G1400) | $939 | — | $939 | 8.34% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY INC | PO BOX 11177 SOUTH BEND, IN 46634 | ANTHEM LIFE INSURANCE COMPANY (G1400) | $82 | $621 | $703 | 6.25% |
No Schedule C service providers reported on this filing.
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 | 132 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 132 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. (G2001) | 105 | $832K |
| Dental | HEALTH RESOURCES, INC. | 100 | $51K |
| Vision | GUARDIAN | 132 | $68K |
| Life insurance(2 contracts, 2 carriers) | GUARDIAN | 132 | $80K |
| Short-term disability | GUARDIAN | 132 | $68K |
| Long-term disability | GUARDIAN | 132 | $68K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 132 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.