| 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 | 1.55% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRI STATE JOINT FUND EIN 06-0850110 AFFILIATED ORG. | Plan Administrator; Claims processing; Direct payment from the plan Service code 12 | — | $499K |
| ANTHEM BLUE CROSS BLUE SHIELD EIN 06-1475928 NONE | Insurance agents and brokers; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Non-monetary compensation; Contract Administrator; Other commissions Service code 12 | — | $345K |
| CLAIMS PROCESSOR EIN 06-0942913 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $188K |
| MORGAN STANLEY EIN 20-8764829 NONE | Account maintenance fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other investment fees and expenses; Other services; Securities brokerage; Investment management fees paid directly by plan; Recordkeeping fees; Investment advisory (plan) Service code 15 | — | $141K |
| FUND MANAGER EIN 06-0942913 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $85K |
| MED CARE MANAGEMENT INC EIN 88-0429522 NONE | Other fees; Other services Service code 49 | — | $61K |
| HMC HEALTHWORKS INC EIN 75-3189468 NONE | Other services; Other fees Service code 49 | — | $37K |
| TIMOTHY CASEY EIN 06-0942913 EMPLOYER TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $23K |
| ALLEGIANT RX EIN 02-6015031 NONE | Contract Administrator; Other fees; Consulting (general) Service code 13 | 51 GOFFSTOWN ROAD MANCHESTER, NH 03102 | $21K |
| EARNEST PARTNERS LLC NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 1180 PEACHTREE STREET ATLANTA, GA 30309 | $20K |
| REYNOLDS CONSULTING SERVICES,LLC NONE | Investment advisory (plan); Investment management fees paid directly by plan Service code 27 | 25 NEWBRIDGE ROAD HICKSVILLE, NY 11801 | $15K |
| PREFERRED NETWORK ACCESS EIN 36-4018433 NONE | Other services; Other fees Service code 49 | — | $14K |
| THOMAS BAYUSIK EIN 06-0942913 UNION TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $12K |
| MFS INVESTMENT MGMT NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 111 HUNTINGTON AVE BOSTON, MA 02199 | $12K |
| ALLIANCE BERNSTEIN NONE | Investment management; Investment management fees paid directly by plan Service code 28 | 501 COMMERCE STREET NASHVILLE, TN 37203 | $12K |
| DAVIS VISION EIN 11-3051991 NONE | Other fees; Other services Service code 49 | — | $9K |
| OPTUM RX EIN 33-0441200 NONE | Other fees; Other services Service code 49 | — | $7K |
| MPL LLC EIN 06-1537302 NONE | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions 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 | 971 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 68 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1,028 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,067 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 972 | $128K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 972 | $128K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 972 | — |
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.