| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCASCIO HADDEN & DENNIS LLC5 Filed as: LOCASCIO HADDEN & DENNIS, LLC | 250 W 96TH STREET INDIANAPOLIS, IN 46290 | SYMETRA LIFE INSURANCE | — | $97K | $97K | 12.83% |
| LOCASCIO HADDEN & DENNIS LLC3 | 250 W 96TH ST STE 350 INDIANAPOLIS, IN 46260 | UNITED HEALTHCARE INSURANCE COMPANY | $7K | $0 | $7K | 4.55% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANY EIN 35-0781558 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other fees; Claims processing; Float revenue; Other services Service code 12 | PO BOX 951254 CLEVELAND, OH 44193 | $1.1M |
| OUR HEALTH, LLC EIN 27-1353079 NONE | Other services Service code 49 | ONE AMERICAN SQUARE SUITE 2610 INDIANAPOLIS, IN 46282 | $938K |
| COMMUNITY HEALTHPLEX SPORTS CLUB EIN 35-2022402 NONE | Other fees Service code 99 | ONE AMERICA TOWER FITNESS CENTER ONE AMERICA SQUARE, STE 175 INDIANAPOLIS, IN 46282 | $141K |
| CASTLIGHT EIN 26-1989091 NONE | Other services Service code 49 | 121 SPEAR STREET SUITE 300 SAN FRANCISCO, CA 94105 | $100K |
| CIGNA BEHAVIORAL HEALTH, INC EIN 41-1648670 NONE | Contract Administrator; Participant communication; Direct payment from the plan; Claims processing Service code 12 | 11095 VIKING DRIVE, SUITE 30 EDEN PRAIRIE, MN 55344 | $42K |
| BKD, LLP EIN 44-0160260 NONE | Accounting (including auditing) Service code 10 | PO BOX 44998 INDIANAPOLIS, IN 46244 | $23K |
| ST. VINCENT HOSPITAL EIN 35-0869066 NONE | Other fees Service code 99 | MOBILE MAMMOGRAPHY PROGRAM 8550 NAAB ROAD, SUITE 300 INDIANAPOLIS, IN 46260 | $10K |
| TOWERS WATSON EIN 53-0181291 NONE | Actuarial Service code 11 | 191 NORTH WACKER DRIVE SUITE 2100 CHICAGO, IL 60606 | $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 | 1,873 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 283 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPLOYEE BENEFIT SPECIALISTS | 109 | $388K |
| Dental | DELTA DENTAL OF INDIANA | 1,873 | $1.3M |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 1,359 | $165K |
| Life insurance | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,618 | $859K |
| Short-term disability | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,567 | $639K |
| Long-term disability | AMERICAN UNITED LIFE INSURANCE COMPANY | 1,567 | $639K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE | 1,552 | $753K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 671 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,873 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.