| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFIT ADMINISTRATORS OF CT3 | 109 SANFORD ST HAMDEN, CT 06514 | ANTHEM LIFE INSURANCE COMPANY | $969 | — | $969 | 1.73% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRI STATE JOINT FUND EIN 06-0850110 AFFILIATED ORGANIZATION | Claims processing; Plan Administrator; Direct payment from the plan Service code 12 | — | $202K |
| MORGAN STANLEY SMITH BARNEY LLC EIN 26-4310632 NONE | Accounting (including auditing); Other services; Securities brokerage commissions and fees; Investment management fees paid directly by plan; Shareholder servicing fees; Other fees; Investment advisory (plan); Securities brokerage; Custodial (securities); Distribution (12b-1) fees; Other investment fees and expenses Service code 10 | — | $153K |
| ANTHEM BLUE CROSS BLUE SHIELD EIN 06-1475928 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Contract Administrator; Float revenue Service code 12 | — | $132K |
| CLAIMS PROCESSOR EIN 06-0942914 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $100K |
| FUND MANAGER EIN 06-0942914 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $64K |
| PREFERRED ACESS NETWORK EIN 36-4018433 NONE | Insurance services; Other fees Service code 23 | 1510 W. 75TH STREET SUITE 250 DARIEN, IL 60561 | $29K |
| MED CARE MANAGEMENT INC EIN 88-0429522 NONE | Other fees; Other services Service code 49 | — | $21K |
| HEALTH MANAGEMENT CONCEPTS, INC EIN 75-3189468 NONE | Other fees; Other services Service code 49 | — | $16K |
| TEAMSTERS RX EIN 02-6015031 NONE | Other services; Contract Administrator; Consulting (general) Service code 13 | 51 GOFFSTOWN ROAD MANCHESTER, NH 03102 | $10K |
| EXPRESS SCRIPTS INC EIN 22-3461740 NONE | Other services; Other fees; Claims processing Service code 12 | — | $9K |
| STRATOSE INC EIN 26-1790538 NONE | Other fees; Insurance services; Other services Service code 23 | — | $8K |
| S M ESPOSITO & COMPANY PC EIN 06-1298465 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $7K |
| MPL LLC EIN 06-1537302 NONE | Insurance brokerage commissions and fees; Other commissions; 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 | 377 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 44 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 735 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 378 | $56K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 378 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 378 | — |
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.