| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PREFERRED BENEFITS SERVICES AGENCY3 Filed as: PREFERRED BENEFITS SERVICE AGENCY | 1201 U.S. RTE 23N DELAWARE, OH 43015 | ANTHEM LIFE INSURANCE COMPANY (G1400) | $67K | $0 | $67K | 56.78% |
| SHAWAN MARQUIS AGENCY INC3 | 110 EAST WILSON BRIDGE RD STE 260 COLUMBUS, OH 43085 | ANTHEM LIFE INSURANCE COMPANY (G1400) | $931 | — | $931 | 0.79% |
| PREFERRED BENEFITS SERVICES AGENCY3 Filed as: PREFERRED BENEFITS SERVICE AGENCY | PO BOX 868 DELAWARE, OH 43015 | VISION SERVICE PLAN | $2K | — | $2K | 9.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY (G1728) EIN 31-1440175 ADMINISTRATIVE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Other services; Contract Administrator Service code 12 | — | $8K |
| ANTHEM LIFE INSURANCE COMPANY-G1400 EIN 35-0980405 SALES/BASE COMMISSION | Insurance brokerage commissions and fees; Other commissions; Insurance agents and brokers 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 | 156 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | COMMUNITY INSURANCE COMPANY (G1728) | 383 | $2.2M |
| Vision | VISION SERVICE PLAN | 130 | $19K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY (G1400) | 128 | $118K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY (G1400) | 128 | $118K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY (G1400) | 128 | $118K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 383 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.