| 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 | $2K | — | $2K | 1.72% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRI STATE JOINT FUND EIN 06-0850110 AFFILIATED ORG. | Direct payment from the plan; Plan Administrator; Claims processing Service code 12 | — | $479K |
| ANTHEM BLUE CROSS BLUE SHIELD EIN 06-1475928 NONE | Non-monetary compensation; Claims processing; Insurance agents and brokers; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Float revenue; Other commissions Service code 12 | — | $323K |
| UBS FINANCIAL SERVICES INC EIN 13-2638166 NONE | Other fees; Investment management fees paid directly by plan; Investment advisory (plan) Service code 27 | — | $220K |
| CLAIMS PROCESSOR EIN 06-0942913 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $169K |
| FUND MANAGER EIN 06-0942913 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $77K |
| MED CARE MANAGEMENT INC EIN 88-0429522 NONE | Other services; Other fees Service code 49 | — | $59K |
| ADMINISTRATIVE STAFF EIN 06-0942913 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $56K |
| HMC HEALTHWORKS INC EIN 75-3189468 NONE | Other services; Other fees Service code 49 | — | $36K |
| PREFERRED NETWORK ACCESS EIN 36-4018433 NONE | Other fees; Other services Service code 49 | — | $32K |
| ALLEGIANT RX EIN 02-6015031 NONE | Other fees; Consulting (general); Contract Administrator Service code 13 | 51 GOFFSTOWN ROAD MANCHESTER, NH 03102 | $21K |
| S M ESPOSITO & COMPANY INC EIN 06-1298465 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $19K |
| EXPRESS SCRIPTS, INC EIN 22-3461740 NONE | Other services; Other fees Service code 49 | — | $9K |
| DAVIS VISION EIN 11-3051991 NONE | Other services; Other fees Service code 49 | — | $8K |
| MPL LLC EIN 06-1537302 NONE | Other commissions; Insurance brokerage commissions and fees; 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 | 941 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 57 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1,119 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 952 | $119K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 952 | $119K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 952 | — |
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.