| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: ANTHEM BLUE CROSS BLUE SHIELD | 1351 WM. HOWARD TAFT RD CINCINNATI, OH 45206 | COMMUNITY INSURANCE CO | — | — | $0 | 0.00% |
| PHELAN INSURANCE AGENCY, INC.3 Filed as: PHELAN INSURANCE AGENCY | 863 EAST MAIN ST VERSAILLES, OH 45360 | HUMANA INSURANCE CO LIFE PLAN | $13K | — | $13K | 100.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM-COMMUNITY INS CO EIN 31-1440175 THIRD PARTY ADMINISTRATOR | Contract Administrator; Other fees; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Other services Service code 12 | 3350 PEACHTREE ROAD ATLANTA, GA 30326 | $66K |
| MCCRATE, DELAET & CO CPA EIN 34-1205613 AUDITOR | Accounting (including auditing) Service code 10 | P.O. BOX 339 SIDNEY, OH 45365 | $20K |
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 PLAN ADMINISTRATION | Insurance brokerage commissions and fees; Other commissions; Insurance agents and brokers Service code 22 | — | $0 |
| EXPRESS SCRIPTS, INC. EIN 31-1714795 PRESCRIPTION DRUG REBATES | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | 1 EXPRESS WAY ST. LOUIS, MO 63121 | $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 | 116 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HUMANA INSURANCE CO LIFE PLAN | 234 | $13K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE CO | 234 | $200K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 234 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.