WELCOME
Opening doors in manufacturing
Benefits Reimagined:�Smarter Strategies, Stronger Outcomes
AGENDA | |
8.00 – 8.30 | Breakfast / Networking |
8.30 - 8.40 | Welcome |
8.40 – 9.00 | Matt Richard, Vice President, Alliant Insurance Services |
9.00 – 9.20 | Jake Bishop, Regional Sales Director, Garner Health |
9.20 – 9.50 | Lee Palmer, Executive Director, Wells Fargo (National Co Head of ESOP Advisory) |
9.50 – 10.20 | Kathleen Monahan, Financial Advisor, Alliant Retirement Consulting Joseph D’Alconzo, Retirement Plan Consultant – Lead, Alliant Retirement Consulting |
10.20 – 10.30 | Q & A |
10.30 – 11.00 | Tour of CBT Company (Optional) |
Benefits Reimagined: Smarter Strategies, Stronger Outcomes!
July 10th, 2025
Matt Richard
Vice President
Alliant Insurance Services, Inc.
��Medical Insurance�Funding
4
Agenda
Danielle Dunn
Alliant Insurance Services
Matt Malkin
Alliant Insurance Services
What is Funding?
5
*45% of area Manufacturers are Fully-Insured while 50% are Self-Insured w/Stop Loss (2025 Manufacturing and Wholesale Distribution Compensation & Benefits Benchmarking Survey)
Fully-Insured vs. �Self-Insured Comparison
Self-Insured Refresher
Provider
Carrier/Admin
Employer
Employee
Works like a fully- insured plan
Same carrier
Same plan design
Same ID card with carrier/administrator name
Works like a fully- insured plan
Same network and access
Same account management team
Still makes all claims decisions, processes claims and send payment to provider
In carrier self-funded model, can act as claim fiduciary if contracted to provide service
Pays administrator fixed fee (PEPM) to access network, process and pay claims, answer customer service calls on their behalf
Pays reinsurance carrier a fixed fee (PEPM) to insure program from having catastrophic claim on a single individual (stop-loss coverage)
Pays reinsurance carrier premium (PEPM) to insure program from having extremely high claims on group as a whole (aggregate stop-loss coverage)
Funding Options
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Fully-Insured Non-Refunding | | Fully-Insured Refunding | | Minimum Premium / Level Funding | | Self-Funded with Stop-Loss | | Self-Funded without Stop Loss |
| | | | | | | | Unlimited Claims Liability |
| | | | Margin | | | | |
Margin | ||||||||
Pooling Charges | | Pooling Charges | | Pooling Charges | | Optional Margin | | |
Administration | | Administration | | Administration | | Stop Loss Premiums | | Optional Margin |
Administration* | Administration* | |||||||
Paid Claims (Excluding Pooled Claims) | | Paid Claims (Excluding Pooled Claims) | | Paid Claims (Excluding Pooled Claims) | | Paid Claims (Excluding Pooled Claims) | | Paid Claims (Excluding Pooled Claims) |
| | | | |||||
| | | |
Less risk, less flexibility More risk, more flexibility
*Includes ACA fees (PCORI), claim processing, network access
Funding and Risk Management
Fully-Insured
Minimum Premium
Self-Funding
Fully-Insured
(Dividend Eligible)
Cost Savings
Financial Risk/Reward
High
High
Low
Low
Gap Funding
Self-Funded vs. Fully Insured
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July 10, 2025
How Provider Performance Impacts Health Plan Costs
Introductions
Today’s Speaker
Jake Bishop
Regional Sales Director
Garner Health
jake.bishop@getgarner.com
Medical trend is accelerating and employers need new solutions that do not simply shift cost to employees
Source: Data from large employer consultants, Kaiser Family Foundation and US Federal Reserve, KFF, The American Journal of Medicine. “Healthcare services” defined as greater than one specialist claim.
1 in 100
Employees declare bankruptcy when receiving healthcare services
Average US Employer Medical Trend
US Family Functional Insurance
Proprietary & confidential. Do not distribute.
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These accelerating costs are driven by declining quality and increasing prices across all types of care
Source: Data from the Bureau of Labor Statistics, Health Affairs, Kaiser Family Foundation, American Joint Replacement Registry and Garner.
Increasing Prices
Declining Quality
% of Surgeries Performed Against Guideline
(e.g. before conservative treatment applied, using a maximally invasive technique,
or inappropriate for patient)
Average Price of Top 25 Major Surgeries
31% more than overall US price inflation during the same time period
Proprietary & confidential. Do not distribute.
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Good news: healthcare cost and quality can be dramatically improved by getting more care to the best performing doctors
Data shown for average of Top 30 US Cities. Data from Health Affairs, Kaiser Family Foundation, American Joint Replacement Registry and Garner.
Fairer Prices
Higher Quality
Average Price of Top 25 Major Surgeries
% of Surgeries Performed Against Guideline
(e.g. before conservative treatment applied, using a maximally invasive technique,
or inappropriate for patient)
of doctors
of doctors
of doctors
of doctors
Proprietary & confidential. Do not distribute.
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The key to lowering healthcare costs while improving outcomes is understanding the performance of individual doctors
Source: Based on Garner’s analysis of medical claims nationally
Complication rates after joint replacement surgery
Doctors
Practicing at those hospitals
Hospitals
US News and World Report Top Hospitals
40%
30%
20%
10%
0%
Cedars Sinai
NYU
UCLA
Mayo Clinic
Top Performing Doctors
40%
30%
20%
0%
10%
Proprietary & confidential. Do not distribute.
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In addition to quality variation, healthcare transparency data show a large opportunity to identify low cost local providers
Cost of Joint Replacement by Doctor (New York City, Cigna OAP)
Proprietary & confidential. Do not distribute.
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To illustrate the power of provider choice, we pulled the most popular local doctors from a Chicago employer before and after deploying a steerage program
THE MOST POPULAR SPINE DOCTOR AMONG EMPLOYEES…
Dr. Carl Graf�Spine Orthopedist
NPI: 1700981107�Chicago, IL
Before Implementing steerage
After Implementing steerage
Dr. Christopher Dewald�Spine Orthopedist
NPI: 1952334948�Chicago, IL
5
0
5
1
TOP PROVIDER
Proprietary & confidential. Do not distribute.
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Proprietary & confidential. Do not distribute.
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Proprietary & confidential. Do not distribute.
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Before Garner, this employer had significant cost from low quality care. After Garner, this improved quickly due to members seeing Top Providers.
|
|
0 |
0 |
0 |
0 |
0 |
Members Seen | | 5 | ||
| ...Who Had Surgery before PT | | 3 | |
...Who Had their Surgery Inpatient | | 2 | |
...Who Had Maximally Invasive Technique | | 3 | |
...Who Had Complications After Surgery | | 2 | |
...Who Had a Revision Surgery | | 2 | |
Total paid claims | | $172,415 | ||
Dr. Dewald |
NPI: 1952334948 |
Dr. Graf |
NPI: 1700981107 |
$69,160 |
Actual employer results before and with Garner
$0
$18,750
TOP PROVIDER
Total member responsibility
5
Comparison of 2 Chicago-area spine orthopedists
Before Garner
With Garner
Proprietary & confidential. Do not distribute.
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Data-driven steerage with proper incentivization delivers unmatched engagement and cost reduction
A NON-DISRUPTIVE SOLUTION WITH GAME-CHANGING BENEFITS
-12%
lower plan cost PEPM
80%
lower employee out-of-pocket
42%
Members use Garner to find a doctor
For fully insured and self funded employers
Proprietary & confidential. Do not distribute.
22
Thank You!
Introduction to Employee Stock Ownership Plans (ESOPs)
Wells Fargo ESOP Advisory
Lee Palmer
Executive Director, Wells Fargo
National Head of ESOP Advisory
Confidential – For Discussion & General Information Purposes Only
ESOP basics
An ESOP is a vehicle for ownership transition
and an employee benefit
What is an Employee Stock Ownership Plan?
The ESOP can borrow to buy Company stock.
The ESOP option
ESOP Benefits: Business Owner, Employees & Companies
Employee Stock Ownership Plans (ESOPs) provide benefits for the owner, the employees, and the company.
ESOP basics
Transaction Cash Flows
Annual Transactions
Cash
Stock
ESOP Loan
Cash
ESOP
Shareholder
Company
Bank
Cash
Bank Loan
3
2
1
Stock is allocated
ESOP Loan�Payment
Contribution dividend
S distribution
ESOP
Employee Participant
Company
Bank
Bank Loan�Payment
3
2
1
The Leveraged ESOP
Purposes an ESOP Can Serve
Beneficial versus Direct Ownership
Which Companies Should Consider an ESOP?
The 0% to 100% S Corporation ESOP
ESOP Company transaction financing with enhanced cash flows
| Mezzanine/Seller (Possible) 0.5x – 1.0x EBITDA |
| Private Equity Seller |
| Senior (Possible) 2x to 3x EBITDA |
| Other |
Valuation Multiple 6.0x
Senior
2nd Lien, Mezzanine
or Seller
PE/Seller
Existing Qualified �Plan
Research results on employee-ownership
Conducted by trade associations, universities and other institutions interested in employee ownership
ESOP Trade Associations
NCEO – National center for employee ownership goal is to help employee ownership thrive.
TEA – The ESOP Association educates about and advocates for employee ownership with an emphasis on ESOPs.
ESCA – Employee owned S corporations of America advocates exclusively for S Corporation ESOPs.
EOX – Works to expand employee ownership by creating and supporting non-profit state centers.
Management incentive plans (MIPs) in ESOPs
General Considerations
S Corporation Design Issues
Terms and conditions of various options for MIPs in ESOP transactions
Actual Equity | Equity-based | Non-equity Incentives | ||
Full Value | Appreciation Only | Full Value | Appreciation only | |
|
|
|
|
|
IRC Section 1042 – deferral of capital gains for C Corporations only
Requirements and comparison of 1042 benefits
Comparative example of net proceeds to the seller for an ESOP and non-ESOP sale |
|
Corporate Structure Sequences |
C remains C |
C becomes S |
S remains S |
S becomes C becomes S�( 5-year waiting period) |
Computation of Net Proceeds | |||
Comparison of non-ESOP, C Corp and S Corp sale | |||
| Non-ESOP Sale | C Corp Sale to ESOP 1042 Election | High Basis S Corp |
Gross Sales proceeds | $20,000 | $20,000 | $20,000 |
Tax Basis | - | - | ($15,000) |
Capital Gain Realized | $20,000 | $20,000 | $5,000 |
Federal Capital Gains Tax (20%) | ($4,000) | - | ($1,000) |
Obama Care (2.8%) | ($560) | - | ($140) |
State Tax Rate (6%) | ($1,200) | - | ($300) |
Net Sales Proceeds | $14,240 | $20,000 | $18,5601 |
1 Tax basis in S Corporation increases with undistributed profits. Net sales proceeds = gross sales proceeds less taxes on the sale.
A simple comparison to a third-party sale
Does an ESOP meet the owner’s objectives?
Objective | Sale to Third-Party | Sale to ESOP |
Maximize Value | FMV determined by market | FMV negotiated with Trustee |
Taxation of Gain (1) (Federal & State) | ~ 25 – 35% | ~ 0-25% |
Liquidity & Payout | Upfront plus contingent | Upfront plus fixed & contingent |
Payout Time Period | 3-5 years | Up to 10 years Carried interest 20-25% |
Predictability | Unpredictable | Predictable |
Flexibility | Less Flexible | More Flexible |
Likelihood of Close | Unknown | ~ 100% |
Disruption to Operations | Material (Buyer access to employees & customers) | Minimal (Specialized Deal Team) |
Due Diligence Process | Multiple buyers, detailed | One buyer, streamlined |
Escrows, Reps & Warranties | Onerous | Less contentious, straightforward negotiation |
Employee/Management Impact | Unknown - possibly negative Management changes | Positive Retains Management |
Post-Close Involvement | Buyer’s discretion | Flexible |
Does Plan Meet Objectives? | TBD | TBD |
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ESOP myths
General misconceptions about ESOPs
Myth |
Sounds too good to �be true |
Sensitive information will be disclosed |
Employees do not have the funds |
Participants will vote on all matters |
Owners may get a higher price selling to a third party |
Myth Debunked |
ESOPs have been around for almost 50 years. There has been support for the ESOP tax benefits in Congress from both sides of the house. There are many successful ESOP owned companies. |
The required disclosures under ERISA are the components of the participant statements - number of shares and the per share value. |
The Company funds the ESOP’s purchase of stock. It is rare to have the employees give up compensation or invest personal funds. |
The participants may vote on major issues: sale of all or substantially all the corporate assets, merger, dissolution, liquidation and reorganization (similar to public company shareholders). |
The ESOP can pay fair market value under ERISA. The fair market value can be a control price if the ESOP ends up with control. |
Benefits Reimagined
AMIP Cincinnati
July 10,2025
Presented By:
Kathleen Monahan & Joseph D’Alconzo of Alliant Insurance Services, Inc.
AlliantRetirementConsulting.com | For Informational Purposes Only. Not intended as Legal or Tax advice. Advisory Services offered through Alliant Retirement Consulting, a federally Registered Investment Advisor.
401(k)/403(b) Employer Match or Profit Sharing Contributions Reimagined
2
Match Formulas
AlliantRetirementConsulting.com | For Informational Purposes Only. Not intended as Legal or Tax advice.
Advisory Services offered through Alliant Retirement Consulting, a federally Registered Investment Advisor.
3
Reimagine Different Match Models
40
Simple Stretch Match:
Simple Traditional Match:
Tiered Match:
contribution (4.5% match)
Multiple Formulas:
amount
Fixed Dollar:
AlliantRetirementConsulting.com | For Informational Purposes Only. Not intended as Legal or Tax advice. Advisory Services offered through Alliant Retirement Consulting, a federally Registered Investment Advisor.
Reimagine Different Match Models
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Match Based on Service:
AlliantRetirementConsulting.com | For Informational Purposes Only. Not intended as Legal or Tax advice. Advisory Services offered through Alliant Retirement Consulting, a federally Registered Investment Advisor.
50% of first 6% of employee contribution 75% of first 6% of employee contribution 100% of first 6% of employee contribution
Match Based on Employee Groups
100% of first 6% of employee contribution 75% of first 6% of employee contribution 50% of first 6% of employee contribution
Match with a Cap
All the above, plus any type of discretionary matching contribution is subject to Average Contribution Percentage (ACP) testing. Must be a fair formula to prevent Highly Compensated Employees (HCE) and Owners from receiving a greater benefit than the Non-highly Compensated Employees (NHCE)
Profit Sharing Allocations
AlliantRetirementConsulting.com | For Informational Purposes Only. Not intended as Legal or Tax advice.
Advisory Services offered through Alliant Retirement Consulting, a federally Registered Investment Advisor.
Security wage base
6
Non-Qualified Plans aka Top-Hat Plan
AlliantRetirementConsulting.com | For Informational Purposes Only. Not intended as Legal or Tax advice. Advisory Services offered through Alliant Retirement Consulting, a federally Registered Investment Advisor.
43
Non-Qualified Deferred Compensation (NQDC) Plans
AlliantRetirementConsulting.com | For Informational Purposes Only. Not intended as Legal or Tax advice. Advisory Services offered through Alliant Retirement Consulting, a federally Registered Investment Advisor.
44
83% of Fortune 500 companies offer nonqualified deferred compensation plans.1 Here are three reasons why:
Attract talent
~90% of employers offer a NQ plan to have a more competitive benefits package2
Retain employees
~ 83% of employers offer a NQ plan to engage and retain talent2
Reward employees
> 43% of employers offer a NQ plan to help eligible employees accumulate assets2
1 Private Pensions: IRS and DOL Should Strengthen Oversight of Executive Retirement Plans, US Government Accountability Office, 2020
22022 Non-Qualified Plan Survey, Plan Sponsor Council of America, 2022
NQDC Plans Allow for Various Types of Deferrals
AlliantRetirementConsulting.com | For Informational Purposes Only. Not intended as Legal or Tax advice. Advisory Services offered through Alliant Retirement Consulting, a federally Registered Investment Advisor.
45
Funding Vehicles
AlliantRetirementConsulting.com | For Informational Purposes Only. Not intended as Legal or Tax advice. Advisory Services offered through Alliant Retirement Consulting, a federally Registered Investment Advisor.
46
Employer Stock Option Plans (ESOP)
AlliantRetirementConsulting.com | For Informational Purposes Only. Not intended as Legal or Tax advice. Advisory Services offered through Alliant Retirement Consulting, a federally Registered Investment Advisor.
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$400K
Tax savings
No
taxes
Company:
$1M taxable income
Distributes $400K dividend to owner (40% of $1M)
Owner
Owner pays $400K to IRS for taxes
After ESOP (company 100% ESOP owned)
Company:
$1M taxable income
Distributes $0
100%
ESOP
owned
Why consider an ESOP?
Reduce tax liability
Before ESOP
IRS and state
IRS and state
This example is for illustrative purposes only.
For financial professional and plan sponsor use only PQ11065-08 | 863573-062019 | 06/2021
Employer Stock Option Plans (ESOP)
Getting started
What firms are good candidates?
Firms of all shapes and sizes. Over 6,000 firms in the U.S. have over 10.5 million employee owners today.*
AlliantRetirementConsulting.com | For Informational Purposes Only. Not intended as Legal or Tax advice. Advisory Services offered through Alliant Retirement Consulting, a federally Registered Investment Advisor.
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Closely held corporation (Chapter C or S)
History of profitability and strong cash flows
Employee- centered culture
*The ESOP Association, June 2021.
For financial professional and plan sponsor use only PQ11065-08 | 863573-062019 | 06/2021
Questions
AlliantRetirementConsulting.com | For Informational Purposes Only. Not intended as Legal or Tax advice. Advisory Services offered through Alliant Retirement Consulting, a federally Registered Investment Advisor.
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Q & A�(All Speakers)
Opening doors in manufacturing
OPTIONAL TOUR OF CBT COMPANY
10.30 – 11.00
THERE’S NOTHING STANDARD ABOUT CBT SERVICE
OUR MISSION
At CBT, our mission is to be recognized as the best business partner for our customers, our suppliers, our CBT families, and the communities we serve.