| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFIT ADMINISTRATORS OF CT3 | 23 MAIDEN LANE NORTH HAVEN, CT 06473 | ANTHEM LIFE INSURANCE COMPANY | $1K | — | $1K | 1.55% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRI STATE JOINT FUND EIN 06-0850110 AFFILIATED ORGANIZATION | Claims processing; Direct payment from the plan Service code 12 | — | $371K |
| ANTHEM BLUE CROSS BLUE SHIELD EIN 06-1475928 NONE | Other services; Claims processing; Contract Administrator; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $256K |
| MANNING & NAPIER ADVISORS, INC EIN 45-3240790 NONE | Investment management fees paid indirectly by plan; Investment management fees paid directly by plan; Investment management Service code 28 | 290 WOODCLIFF DRIVE FAIRPORT, NY 14450 | $99K |
| FUND MANAGER EIN 04-2589472 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $65K |
| HAMLIN CAPITAL MANAGEMENT LLC EIN 52-2344187 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | 640 FIFTH AVENUE 6TH FLOOR NEW YORK, NY 10019 | $62K |
| CLAIMS PROCESSOR EIN 04-2589472 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $45K |
| RAYMOND JAMES ASSOCIATES INC EIN 59-1237041 NONE | Other fees; Investment management fees paid directly by plan; Account maintenance fees; Custodial (securities); Investment advisory (plan) Service code 19 | — | $40K |
| MED CARE MANAGEMENT INC EIN 88-0429522 NONE | Other services; Other fees Service code 49 | — | $38K |
| WINSLOW, EVANS & CROCKER, INC EIN 04-3144652 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | 175 FEDERAL STREET BOSTON, MA 02110 | $35K |
| HMC HEALTHWORKS INC EIN 75-3189468 NONE | Other fees; Other services Service code 49 | — | $28K |
| DHK FINANCIAL ADVISORS INC EIN 02-0464577 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $25K |
| MILLER HOWARD INVESTMENTS INC EIN 14-1710657 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 324 UPPER BYRDCLIFFE RD WOODSTOCK, NY 12498 | $25K |
| PREFERRED ACCESS NETWORK EIN 36-4018433 NONE | Other services; Other fees Service code 49 | — | $23K |
| RHUMBLINE ADVISORS EIN 04-3076646 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 265 FRANKLIN STREET 21ST FLOOR BOSTON, MA 02110 | $15K |
| ALLEGIANT RX EIN 02-6015031 NONE | Other fees; Consulting (general); Contract Administrator Service code 13 | 91 GOFFSTOWN ROAD MANCHESTER, NH 03102 | $11K |
| EXETER TRUST COMPANY EIN 02-0476209 NONE | Direct payment from the plan; Custodial (securities); Other fees; Account maintenance fees Service code 19 | 290 WOODCLIFF DRIVE FAIRPORT, NY 14450 | $11K |
| LARRY KEEFE EIN 04-2589472 EMPLOYER TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $11K |
| FRANK ROSSI EIN 04-2589472 UNION TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $7K |
| DAVIS VISION EIN 11-3051991 NONE | Other services; Other fees Service code 49 | — | $6K |
| ROBERT SULLIVAN EIN 04-2589472 EMPLOYER TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $6K |
| OPTUM RX EIN 33-0441200 NONE | Other fees; Other services; Claims processing Service code 12 | — | $5K |
| MPL LLC EIN 06-1537302 NONE | Insurance brokerage commissions and fees; Other commissions; Insurance agents and brokers Service code 22 | — | $0 |
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 | 714 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 58 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 604 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,376 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 753 | $93K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 753 | $93K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 753 | — |
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.