| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFIT ADMINISTRATORS OF CT3 | 109 SANFORD STREET HAMDEN, CT 06514 | ANTHEM LIFE INSURANCE COMPANY | $4K | — | $4K | 1.73% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRI STATE JOINT FUND EIN 06-0850110 AFFILIATED ORGANIZATION | Plan Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $853K |
| ANTHEM BLUE CROSS BLUE SHIELD EIN 06-1475928 NONE | Other services; Float revenue; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | 3350 PEACHTREE ROAD ATLANTA, GA 30326 | $556K |
| CLAIMS PROCESSOR EIN 06-0944011 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $229K |
| PREFERRED ACCESS NETWORK EIN 36-4018433 NONE | Other fees; Insurance services Service code 23 | — | $163K |
| JAMES INVESTMENT RESEARCH, INC EIN 31-0891459 NONE | Investment management; Direct payment from the plan Service code 28 | 1349 FARIGROUND ROAD XENIA, OH 45385 | $124K |
| MED CARE MANAGEMENT INC EIN 88-0429522 NONE | Other services; Other fees Service code 49 | — | $97K |
| FUND CLERK EIN 06-0944011 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $77K |
| S M ESPOSITO & COMPANY PC EIN 06-1298465 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $76K |
| HMC HEALTHWORKS EIN 75-3189468 NONE | Other fees; Other services Service code 49 | 18 NORTH MAIN STREET WEST HARTFORD, CT 06107 | $68K |
| TEAMSTERS RX EIN 02-6015031 NONE | Other services; Consulting (general); Contract Administrator Service code 13 | 51 GOFFSTOWN ROAD MANCHESTER, NH 03102 | $38K |
| INVESTMENT CONSULTING SERVICE EIN 32-0016703 NONE | Consulting fees; Investment advisory (plan); Direct payment from the plan Service code 27 | — | $35K |
| EXPRESS SCRIPTS INC EIN 22-3461740 NONE | Other fees; Other services Service code 49 | — | $34K |
| STRATOSE INC EIN 26-1790538 NONE | Other fees; Other services Service code 49 | — | $19K |
| DAVIS VISION EIN 11-3051991 NONE | Other services; Other fees Service code 49 | — | $16K |
| M&T BANK EIN 16-0538020 NONE | Direct payment from the plan; Other fees; Custodial (securities); Float revenue Service code 19 | ONE MT PLAZA BUFFALO, NY 14203 | $15K |
| RHUMBLINE ADVISORS EIN 04-3076646 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | 265 FRANKLIN STREET 21ST FLOOR BOSTON, MA 02110 | $15K |
| MICHAEL RINALDI EIN 06-0944011 UNION TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $9K |
| PAUL AYOUB EIN 06-0944011 EMPLOYER TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $9K |
| MPL LLC EIN 06-1537302 NONE | Other commissions; Insurance agents and brokers; 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 | 1,702 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 75 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 781 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,558 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 1,844 | $218K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 1,844 | $218K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,844 | — |
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.