| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL OWEN3 | 611 HALLECK WAY INDIANAPOLIS, IN 46234 | ANTHEM INSURANCE COMPANIES, INC. | $960 | $0 | $960 | 0.64% |
| MICHAEL OWEN3 Filed as: MICHAEL J OWEN | 611 HALLECK WAY INDIANAPOLIS, IN 46234 | ANTHEM LIFE INSURANCE COMPANY | $1K | $0 | $1K | 9.76% |
| MICHAEL OWEN3 | 611 HALLECK WAY INDIANAPOLIS, IN 462348534 | VISION SERVICE PLAN | $153 | $0 | $153 | 9.63% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| I.A.T.S.E. EIN 35-0415280 N/A | Other fees Service code 99 | — | $18K |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 N/A | Accounting (including auditing) Service code 10 | — | $16K |
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 | 105 | 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) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 15 | $149K |
| Dental | ANTHEM INSURANCE COMPANIES, INC. | 15 | $149K |
| Vision | VISION SERVICE PLAN | 8 | $2K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 105 | $14K |
| Other(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY | 157 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 157 | — |
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.