| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HYLANT GROUP INC3 | 811 MADISON AVENUE TOLEDO, OH 43604 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $24K | $7K | $31K | 123.82% |
| FMLA SOURCE INC5 | 455 N CITYFRONT PLZ DR 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $7K | $7K | 29.11% |
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $5K | $5K | 19.39% |
| HYLANT GROUP INC3 | 811 MADISON AVENUE TOLEDO, OH 43604 | DELTA DENTAL OF INDIANA | $14K | — | $14K | 100.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES INC EIN 35-0781558 BENEFIT ADMINISTRATOR | Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | 220 VIRGINIA AVE INDIANAPOLIS, IN 46204 | $355K |
| INGENIO RX EIN 82-3062245 BENEFIT ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Contract Administrator; Float revenue Service code 12 | 450 HEADQUARTERS PLZ MORRISTOWN, NJ 07960 | $50K |
| HYLANT GROUP INC | Insurance agents and brokers Service code 22 | — | $4K |
| DELTA DENTAL OF INDIANA EIN 35-1545647 BENEFIT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | 225 S EAST STREET INDIANAPOLIS, IN 46202 | $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 | 468 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 474 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES INC | 392 | $976K |
| Dental | DELTA DENTAL OF INDIANA | 374 | $14K |
| Vision | ANTHEM INSURANCE COMPANIES INC | 392 | $976K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 459 | $25K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 459 | $25K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 459 | $25K |
| Prescription drug | ANTHEM INSURANCE COMPANIES INC | 392 | $976K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES INC | 392 | $976K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 459 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 459 | — |
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.