| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD 5TH FLOOR ROLLING MEADOWS, IL 60008 | ANTHEM INSURANCE COMPANIES, INC. | $21K | — | $21K | 2.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD 5TH FLOOR ROLLING MEADOWS, IL 60008 | ANTHEM LIFE INSURANCE COMPANY | $31K | — | $31K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 NONE | Float revenue; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $765K |
| INGENIORX, INC. | Claims processing; Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $473K |
| M&Z LLP NONE | Other fees Service code 99 | 101 N POLK ST MONROE, IN 46772 | $216K |
| BKD, LLP NONE | Accounting (including auditing) Service code 10 | 200 E. MAIN STREET, SUITE 700 FORT WAYNE, IN 46802 | $31K |
| HYLANT GROUP NONE | Insurance agents and brokers Service code 22 | 811 MADISON AVE TOLEDO, OH 43604 | $16K |
| INGENIORX, INC EIN 82-3062245 NONE | Float revenue; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $6K |
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 | 1,511 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 28 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,539 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 1,012 | $879K |
| Dental | ANTHEM INSURANCE COMPANIES, INC. | 1,012 | $879K |
| Vision | ANTHEM INSURANCE COMPANIES, INC. | 1,012 | $879K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 1,523 | $311K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. | 1,012 | $879K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 1,523 | $311K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,523 | — |
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.