| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RYAN COLVIN3 | PO BOX 11177 SOUTH BEND, IN 46634 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $38K | — | $38K | 1.48% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY, INC | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $2K | $2K | 0.09% |
| RYAN COLVIN3 | PO BOX 11177 SOUTH BEND, MI 46634 | BLUE CARE NETWORK OF MICHIGAN | $20K | — | $20K | 1.49% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY, INC | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | BLUE CARE NETWORK OF MICHIGAN | $0 | $2K | $2K | 0.12% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY, INC | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | DELTA DENTAL OF MICHIGAN | $0 | $24K | $24K | 9.20% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY, INC | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $37K | $16K | $53K | 21.70% |
| BENEFITS PARTNER LLC3 | 38233 MOUND RD BLDG F STERLING HEIGHTS, MI 48310 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 0.72% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY, INC | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | $6K | $20K | 21.77% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY, INC | PO BOX 11107 FORT WAYNE, IN 468551107 | VISION SERVICE PLAN | — | $2K | $2K | 3.27% |
| EMPLOYEE NAVIGATOR, LLC3 Filed as: EMPLOYEE NAVIGATOR LLC | 7979 OLD GEORGETOWN RD STE 300 BETHESDA, MD 46855 | VISION SERVICE PLAN | — | $289 | $289 | 0.46% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY, INC | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $4K | $13K | 21.66% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY, INC | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $7K | 22.08% |
| BENEFITS PARTNER LLC3 | 38233 MOUND RD BLDG F STERLING HEIGHTS, MI 48310 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $749 | $749 | 2.45% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY, INC | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $4K | $4K | 20.00% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY, INC | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 20.00% |
| GIBSON INSURANCE AGENCY, INC.3 Filed as: GIBSON INSURANCE AGENCY, INC | 130 S MAIN ST STE 400 SOUTH BEND, IN 46601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 20.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 SERVICE PROVIDER | Claims processing; Contract Administrator Service code 12 | PO BOX 44347 MADISON, WI 53744 | $5K |
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 | 403 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 406 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 379 | $3.9M |
| Dental | DELTA DENTAL OF MICHIGAN | 771 | $260K |
| Vision | VISION SERVICE PLAN | 374 | $63K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 431 | $122K |
| Short-term disability(5 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 431 | $401K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 431 | $59K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 379 | $3.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 771 | — |
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.