| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFIT ADMINISTRATORS OF CT3 | 109 SANFORD ST HAMDEN, CT 06514 | ANTHEM LIFE INSURANCE COMPANY | $1K | — | $1K | 1.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRI STATE JOINT FUND EIN 06-0850110 AFFILIATED ORGANIZATION | Direct payment from the plan; Claims processing; Plan Administrator Service code 12 | — | $262K |
| ANTHEM BLUE CROSS BLUE SHEILD EIN 06-1475928 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Float revenue; Contract Administrator Service code 12 | — | $175K |
| UBS FINANCIAL SERVICES INC EIN 13-2638166 NONE | Other fees; Investment management fees paid directly by plan; Investment advisory (plan); Custodial (securities); Account maintenance fees Service code 19 | — | $147K |
| CLAIMS PROCESSOR EIN 06-0997832 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $112K |
| FUND MANAGER EIN 06-0997832 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $69K |
| MED CARE MANAGEMENT INC EIN 88-0429522 NONE | Other services; Other fees Service code 49 | — | $34K |
| PREFERRED NETWORK ACCESS EIN 36-4018433 NONE | Insurance services; Other fees; Other services Service code 23 | — | $26K |
| FORMER FUND MANAGER EIN 06-0997832 EMPLOYEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $21K |
| HMC HEALTHWORKS INC. EIN 75-3189468 NONE | Other fees; Other services Service code 49 | — | $19K |
| ALLEGIANT RX EIN 02-6015031 NONE | Other services; Contract Administrator; Consulting (general) Service code 13 | 51 GOFFSTOWN ROAD MANCHESTER, NH 03102 | $10K |
| ROBERT ZIOBROWSKI EIN 06-0997832 UNION TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $5K |
| 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 | 519 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 26 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 220 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 765 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 500 | $75K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 500 | $75K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 500 | — |
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.