| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFIT ADMINISTRATORS OF CT3 | 109 SANFORD ST HAMDEN, CT 06514 | ANTHEM LIFE INSURANCE COMPANY | $701 | — | $701 | 1.56% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRI STATE JOINT FUND EIN 06-0850110 AFFILIATED ORGANIZATION | Plan Administrator; Claims processing; Direct payment from the plan Service code 12 | — | $167K |
| ANTHEM BLUE CROSS BLUE SHIELD EIN 06-1475928 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Float revenue; Claims processing Service code 12 | — | $115K |
| CLAIMS PROCESSOR EIN 06-0942914 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $107K |
| MORGAN STANLEY EIN 20-8764829 NONE | Other investment fees and expenses; Investment management fees paid directly by plan; Other commissions; Securities brokerage; Other services; Investment advisory (plan) Service code 27 | — | $56K |
| FUND MANAGER EIN 06-0942914 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $28K |
| MED CARE MANAGEMENT INC EIN 88-0429522 NONE | Other services; Other fees Service code 49 | — | $19K |
| HMC HEALTHWORKS INC. EIN 75-3189468 NONE | Other services; Other fees Service code 49 | — | $12K |
| ALLEGIANT RX EIN 02-6015031 NONE | Other services; Consulting (general); Contract Administrator Service code 13 | 51 GOFFSTOWN ROAD MANCHESTER, NH 03102 | $7K |
| MASSUCCI & ASSOCIATES NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | 648 MAIN STREET PLANTSVILLE, CT 06479 | $6K |
| OPTUM RX EIN 33-0441200 NONE | Claims processing; Other services; Other fees Service code 12 | — | $4K |
| MPL LLC EIN 06-1537302 NONE | Insurance agents and brokers; Insurance brokerage commissions and fees; 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 | 307 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 42 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 670 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,019 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 312 | $45K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 312 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 312 | — |
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.