| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EPIC3 Filed as: EPIC INS SOLUTIONS AGENCY LLC | PO BOX 221649 LOUISVILLE, KY 40252 | ANTHEM LIFE INSURANCE COMPANY | $27K | — | $27K | 8.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 NONE | Other services; Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $610K |
| INGENIORX, INC. | Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | — | $233K |
| EXPRESS SCRIPTS, INC. EIN 31-1714795 NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | — | $137K |
| M&Z LLP NONE | Other fees Service code 99 | 101 N POLK ST MONROE, IN 46772 | $132K |
| STEPPING STONES UNLIMITED NONE | Consulting (general) Service code 16 | 2300 DREX AVE CINCINNATI, OH 45212 | $84K |
| FIFTH THIRD INSURANCE NONE | Insurance services Service code 23 | 38 FOUNTAIN SQUARE PLAZA CINCINNATI, OH 45202 | $46K |
| BKD, LLP NONE | Accounting (including auditing) Service code 10 | 200 E. MAIN STREET, SUITE 700 FORT WAYNE, IN 46802 | $32K |
| EPIC INSURANCE SOLUTIONS NONE | Insurance services Service code 23 | PO BOX 221649 LOUISVILLE, KY 40223 | $23K |
| HYLANT GROUP NONE | Insurance agents and brokers Service code 22 | 811 MADISON AVE TOLEDO, OH 43604 | $18K |
| FAEGRE BAKER DANIELS, LLP NONE | Legal Service code 29 | 110 W BERRY ST. #2400 FORT WAYNE, IN 46802 | $7K |
| INGENIORX, INC EIN 82-3062245 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Float revenue; 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 | 1,455 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 49 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,506 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 1,838 | $253K |
| Dental | ANTHEM INSURANCE COMPANIES, INC. | 1,838 | $253K |
| Vision | ANTHEM INSURANCE COMPANIES, INC. | 1,838 | $253K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 1,449 | $326K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. | 1,838 | $253K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 1,449 | $326K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,838 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.