| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MOLLIE BEAN3 | 9439 BARCROFT AVE APT A INDIANAPOLIS, IN 46240 | ANTHEM INSURANCE COMPANIES, INC. | $15K | $0 | $15K | 3.54% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 NONE | Other fees; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | 1351 WM. HOWARD TAFT RD. CINCINNATI, OH 452061721 | $383K |
| M&Z, LLP NONE | Accounting (including auditing) Service code 10 | 101 S POLK ST MONROE, IN 46772 | $45K |
| FAEGRE BAKER DANIELS, LLP NONE | Legal Service code 29 | 111 E WAYNE STREET, SUITE 800 260-424-8000 FORT WAYNE, IN 468022600 | $13K |
| BKD, LLP NONE | Accounting (including auditing) Service code 10 | 200 E. MAIN STREET, SUITE 700 260-460-4000 FORT WAYNE, IN 46802 | $11K |
| ZURCHER & ZURCHER NONE | Legal Service code 29 | 101 N. POLK ST, BOX 450 MONROE, IN 46772 | $4K |
| EXPRESS SCRIPTS, INC. EIN 31-1714795 NONE | Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $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 | 1,757 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,757 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 1,757 | $414K |
| Vision | ANTHEM INSURANCE COMPANIES, INC. | 1,757 | $414K |
| Life insurance | ANTHEM INSURANCE COMPANIES, INC. | 1,757 | $414K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. | 1,757 | $414K |
| Other | ANTHEM INSURANCE COMPANIES, INC. | 1,757 | $414K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,757 | — |
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.