| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GENERAL INSURANCE SERVICES INC.3 | 421 FRANKLIN ST MICHIGAN CITY, IN 463603326 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | — | $7K | 5.42% |
| GENERAL INSURANCE SERVICES INC.3 | 4208 CALUMET AVE, SUITE 100 VALPARAISO, IN 46383 | HARTFORD LIFE AND ACCIDENT | $9K | — | $9K | 10.00% |
| GENERAL INSURANCE SERVICES INC.3 | 421 FRANKLIN ST MICHIGAN CITY, IN 463603326 | VISION SERVICE PLAN | $1K | — | $1K | 4.74% |
| GENERAL INSURANCE SERVICES INC.3 | 421 FRANKLIN ST MICHIGAN CITY, IN 46360 | ANTHEM LIFE INSURANCE COMPANY | $1K | — | $1K | 19.77% |
| INDIANA CHAMBER INSURANCE AGENCY3 Filed as: INDIANA STATE MEDICAL ASSOC | 322 CANAL WALK INDIANAPOLIS, IN 46202 | ANTHEM LIFE INSURANCE COMPANY | -$602 | — | -$602 | -9.77% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 NONE | Contract Administrator; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | — | $186K |
| GENERAL INSURANCE SERVICES INC EIN 35-1164638 NONE | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions 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 | 180 | 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) | 180 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 145 | $174K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 176 | $134K |
| Vision(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 176 | $162K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 176 | $140K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 180 | $93K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 180 | $93K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. | 145 | $174K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.