| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | PO BOX 62689 VIRGINIA BEACH, VA 23466 | ANTHEM LIFE INSURANCE CARRIER | $5K | — | $5K | 7.52% |
| JOHN KAUFMAN3 | 74 BATTERSON PARK ROAD FARMINGTON, CT 06032 | ANTHEM LIFE INSURANCE CARRIER | $3K | — | $3K | 3.76% |
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1393 VETERANS MEMORIAL HWY STE 210N HAUPPAUGE, NY 11788 | ANTHEM LIFE INSURANCE CARRIER | — | $584 | $584 | 0.84% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS, INC. EIN 06-1475928 | Other fees; Float revenue; Investment management fees paid indirectly by plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing Service code 12 | 30 BASSET ROAD NORTH HAVEN, CT 06473 | $396K |
| JOHN KAUFMAN | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | 74 BATTERSON PARK ROAD FARMINGTON, CT 06032 | $0 |
| USI INS SERVICES, LLC EIN 13-3771734 | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | PO BOX 3716 NORFOLK, VA 23514 | $0 |
| WENTWORTH DEANGELIST KAUFMAN | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | 74 BATTERSON PARK ROAD FARMINGTON, CT 06032 | $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 | 839 | 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) | 839 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS, INC. | 1,097 | $445K |
| Life insurance | ANTHEM LIFE INSURANCE CARRIER | 839 | $70K |
| Long-term disability | ANTHEM LIFE INSURANCE CARRIER | 839 | $70K |
| Other(2 contracts, 2 carriers) | ANTHEM HEALTH PLANS, INC. | 1,097 | $515K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,097 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.