| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OLD NATIONAL INSURANCE GROUP3 | 925 WABASH AVENUE SUITE 200 TERRE HAUTE, IN 47807 | ANTHEM INSURANCE COMPANIES, INC (G2001) | $163K | — | $163K | — |
| ONB INSURANCE GROUP INC.0 Filed as: ONB INSURANCE GROUP INC | PO BOX 1705 FORT WAYNE, IN 46801 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $32K | — | $32K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 3RD PARTY ADMINISTRATOR | Plan Administrator; Claims processing; Contract Administrator Service code 12 | 1351 WM. HOWARD TAFT RD. CINCINNATI, OH 452061721 | $0 |
| OLD NATIONAL INSURANCE GROUP EIN 35-0781558 BROKER | Insurance brokerage commissions and fees; Insurance agents and brokers; Insurance services Service code 22 | 925 WABASH SUITE 200 TERRE HAUTE, IN 47807 | $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 | 5,481 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 292 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 51 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 5,824 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC (G2001) | 5,773 | $0 |
| Dental | ANTHEM INSURANCE COMPANIES, INC (G2001) | 5,773 | $0 |
| Vision | ANTHEM INSURANCE COMPANIES, INC (G2001) | 5,773 | $0 |
| Life insurance(3 contracts, 3 carriers) | AETNA LIFE INSUARNCE COMPANY AND AFFILIATES | 6,792 | $0 |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 355 | $0 |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 706 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,792 | — |
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.