| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFIT ADMINISTRATORS OF CT3 | 109 SANFORD ST HAMDEN, CT 06514 | ANTHEM LIFE INSURANCE COMPANY | $766 | — | $766 | 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 | — | $165K |
| ANTHEM BLUE CROSS BLUE SHIELD EIN 06-1475928 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing; Float revenue Service code 12 | — | $110K |
| MORGAN STANLEY SMITH BARNEY LLC EIN 26-4310632 NONE | Distribution (12b-1) fees; Accounting (including auditing); Other investment fees and expenses; Securities brokerage commissions and fees; Other services; Custodial (securities); Securities brokerage; Investment management fees paid directly by plan; Shareholder servicing fees; Other fees; Investment advisory (plan) Service code 10 | — | $90K |
| CLAIMS PROCESSOR EIN 06-0942914 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $82K |
| FUND MANAGER EIN 06-0942914 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $66K |
| MED CARE MANAGEMENT INC EIN 88-0429522 NONE | Other services; Other fees Service code 49 | — | $23K |
| PREFERRED NETWORK ACCESS EIN 36-4018433 NONE | Other services; Other fees Service code 49 | — | $13K |
| HMC HEALTHWORKS INC. EIN 75-3189468 NONE | Other services; Other fees Service code 49 | — | $12K |
| UBS FINANCIAL SERVICES INC. EIN 13-2638166 NONE | Account maintenance fees; Investment advisory (plan); Investment management fees paid directly by plan Service code 27 | — | $11K |
| ALLEGIANT RX EIN 02-6015031 NONE | Consulting (general); Contract Administrator; Other services Service code 13 | 51 GOFFSTOWN ROAD MANCHESTER, NH 03102 | $8K |
| ANTHONY LEPORE EIN 06-0942914 UNION TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $8K |
| S M ESPOSITO & COMPANY PC EIN 06-1298465 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $7K |
| EXPRESS SCRIPTS INC EIN 22-3461740 NONE | Other fees; Claims processing; Other services Service code 12 | — | $6K |
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 | 300 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 44 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 756 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 295 | $44K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 295 | $44K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 295 | — |
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.