| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 30339 | ANTHEM HEALTH PLANS INC | $26K | — | $26K | 2.25% |
| TIMOTHY W GRIMES3 Filed as: TIMOTHY W GRIMES, CIC | 43 FIELD ST WATERBURY, CT 06702 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 13.04% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 30339 | ANTHEM LIFE INSURANCE COMPANY | $2K | — | $2K | 10.89% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DIVERSIFIED ADMINISTRATION CORP EIN 06-0988547 DENTAL TPA | Claims processing Service code 12 | 369 N MAIN ST MARLBOROUGH, CT 06447 | $5K |
| DIGITAL INSURANCE INC EIN 58-2522668 BROKER | Insurance agents and brokers Service code 22 | 400 GALLERIA PKWY SE STE 1950 ATLANTA, GA 30339 | $2K |
| RELIANCE STANDARD LIFE INSURANCE EIN 36-0883760 ASO STD PROVIDER | Claims processing Service code 12 | — | $1K |
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 | 106 | 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) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS INC | 430 | $1.2M |
| Vision | ANTHEM HEALTH PLANS INC | 430 | $1.2M |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 106 | $22K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 101 | $25K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 106 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 430 | — |
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.