| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURT ADVISORY GROUP3 | 307 S. MAIN STREET, SUITE 302 ELKHART, IN 46516 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | — | $8K | $8K | 7.60% |
| NORTH AMERICAN BENEFITS COMPANY5 | 20 VALLEY STREAM PARKWAY, SUITE 310 MALVERN, PA 19355 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | — | $7K | $7K | 7.23% |
| BURT ADVISORY GROUP3 Filed as: BURT ADVISORY GROUP (TO) | 307 S. MAIN STREET, SUITE 203 ELKHART, IN 46516 | THE LINCOLN LIFE INSURANCE COMPANY | — | $8K | $8K | 8.00% |
| NORTH AMERICAN BENEFITS COMPANY5 Filed as: NORTH AMERICAN BENEFIT COMPANY | 20 VALLEY STREAM PARKWAY SUITE 310 MALVERN, PA 19355 | THE LINCOLN LIFE INSURANCE COMPANY | — | $7K | $7K | 7.62% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANY, INC EIN 35-0781558 ASO | Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $383K |
| ANTHEM INSURANCE COMPANY, INC. | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Float revenue; Claims processing Service code 12 | — | $45K |
| AON RISK SERVICES CENTRAL INC. | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | — | $23K |
| ANTHEM INSURANACE COMPANY EIN 35-0781558 ASO | Other fees Service code 99 | — | $5K |
| AON RISK SERVICES CENTRAL, INC. EIN 35-0781558 BROKER | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 450 E. 96TH STREET SUITE 275 INDIANAPOLIS, IN 46240 | $0 |
| EXPRESS SCRIPTS, INC. EIN 31-1714795 EXPRESS SCRIPTS, INC. | Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $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 | 1,934 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,939 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 1,132 | $388K |
| Dental | ANTHEM INSURANCE COMPANIES, INC. | 1,132 | $388K |
| Vision | ANTHEM INSURANCE INC. | 976 | $49K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 1,934 | $100K |
| Long-term disability | THE LINCOLN LIFE INSURANCE COMPANY | 616 | $95K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. | 1,132 | $388K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,934 | — |
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."
No prospect flags tripped on this filing.