| 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 | 1.60% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRI STATE JOINT FUND EIN 06-0850110 AFFILIATED ORG. | Claims processing; Plan Administrator; Direct payment from the plan Service code 12 | — | $498K |
| ANTHEM BLUE CROSS BLUE SHIELD EIN 06-1475928 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Insurance agents and brokers; Float revenue; Contract Administrator; Non-monetary compensation; Claims processing; Other commissions; Other services Service code 12 | — | $341K |
| CLAIMS PROCESSOR EIN 06-0942913 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $177K |
| FUND MANAGER EIN 06-0942913 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $79K |
| MORGAN STANLEY EIN 20-8764829 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Recordkeeping fees; Securities brokerage; Account maintenance fees; Investment management fees paid directly by plan; Other investment fees and expenses; Investment advisory (plan); Other services Service code 15 | — | $75K |
| UBS FINANCIAL SERVICES INC EIN 13-2638166 NONE | Investment advisory (plan); Investment management fees paid directly by plan; Other fees Service code 27 | — | $73K |
| MED CARE MANAGEMENT INC EIN 88-0429522 NONE | Other services; Other fees Service code 49 | — | $61K |
| ADMINISTRATIVE STAFF EIN 06-0942913 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $52K |
| HMC HEALTHWORKS INC EIN 75-3189468 NONE | Other fees; Other services Service code 49 | — | $37K |
| ALLEGIANT RX EIN 02-6015031 NONE | Other fees; Consulting (general); Contract Administrator Service code 13 | 51 GOFFSTOWN ROAD MANCHESTER, NH 03102 | $20K |
| EARNEST PARTNERS LLC NONE | Investment management; Investment management fees paid directly by plan Service code 28 | 1180 PEACHTREE STREET ATLANTA, GA 30309 | $10K |
| DAVIS VISION EIN 11-3051991 NONE | Other services; Other fees Service code 49 | — | $9K |
| OPTUM RX EIN 33-0441200 NONE | Other fees; Other services Service code 49 | — | $8K |
| MFS INVESTMENT MGMT NONE | Investment management; Investment management fees paid directly by plan Service code 28 | 111 HUNTINGTON AVE BOSTON, MA 02199 | $7K |
| ALLIANCE BERNSTEIN NONE | Investment management; Investment management fees paid directly by plan Service code 28 | 501 COMMERCE STREET NASHVILLE, TN 37203 | $7K |
| MPL LLC EIN 06-1537302 NONE | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees 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 | 980 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 60 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1,049 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,089 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 980 | $128K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 980 | $128K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 980 | — |
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.