| 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 | $25K | — | $25K | 7.63% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 NONE | Float revenue; Other fees; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $735K |
| INGENIORX, INC. EIN 82-3062245 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Float revenue; Claims processing Service code 12 | — | $303K |
| EXPRESS SCRIPTS, INC. | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Float revenue Service code 12 | — | $174K |
| M&Z LLP NONE | Other fees Service code 99 | 101 N POL ST MONROE, IN 46772 | $162K |
| STEPPING STONES UNLIMITED NONE | Consulting (general) Service code 16 | 2300 DREX AVE CINCINNATI, OH 45212 | $116K |
| FIFTH THIRD INSURANCE NONE | Insurance services Service code 23 | 38 FOUNTAIN SQUARE PLAZA CINCINNATI, OH 45202 | $58K |
| BKD, LLP NONE | Accounting (including auditing) Service code 10 | 200 E. MAIN STREET, SUITE 700 FORT WAYNE, IN 46802 | $36K |
| EPIC INSURANCE SOLUTIONS NONE | Insurance services Service code 23 | PO BOX 221649 LOUISVILLE, KY 40223 | $30K |
| HYLANT GROUP NONE | Insurance agents and brokers Service code 22 | 811 MADISON AVE TOLEDO, OH 43604 | $23K |
| FAEGRE BAKER DANIELS, LLP NONE | Legal Service code 29 | 110 W BERRY ST. #2400 FORT WAYNE, IN 46802 | $9K |
| EXPRESS SCRIPTS, INC EIN 31-1714795 NONE | Float revenue; Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) 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 | 1,937 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 66 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,009 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 1,374 | $289K |
| Dental | ANTHEM INSURANCE COMPANIES, INC. | 1,374 | $289K |
| Vision | ANTHEM INSURANCE COMPANIES, INC. | 1,374 | $289K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 1,925 | $323K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. | 1,374 | $289K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 1,925 | $323K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,925 | — |
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.