| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFITMALL3 | 6200 CANOGA AVENUE, SUITE 300 WOODLAND HILLS, CA 91367 | PARTNER RE AMERICA INSURANCE COMPANY | — | $11K | $11K | 5.00% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS. AND FIN. SERVICES | 5090 NORTH 40TH STREET, SUITE 100 PHOENIX, AZ 85018 | HCC LIFE INSURANCE COMPANY | $5K | — | $5K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC EIN 35-0781558 NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Direct payment from the plan Service code 12 | — | $188K |
| STEWART C. MILLER EIN 35-1820020 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $184K |
| TFBC LLC EIN 27-3782504 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $43K |
| JOHNSON & KROL, LLC EIN 36-4342024 NONE | Legal; Direct payment from the plan Service code 29 | — | $42K |
| CATAMARAN EIN 11-2581812 NONE | Direct payment from the plan; Other services Service code 49 | — | $37K |
| HINES AND ASSOCIATES EIN 36-3545085 NONE | Other services; Direct payment from the plan Service code 49 | — | $23K |
| DELTA DENTAL EIN 35-1545647 NONE | Claims processing; Other services; Contract Administrator; Direct payment from the plan Service code 12 | — | $20K |
| STRATEGIC CAP INVEST ADVISORS, INC EIN 36-4268991 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $20K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $18K |
| HUNT INSURANCE AGENCY NONE | Insurance brokerage commissions and fees; Direct payment from the plan; Insurance agents and brokers Service code 22 | 12000 SOUTH HARLEM AVENUE PALOS HEIGHTS, IL 60463 | $11K |
| RED CARD SYSTEMS LLC EIN 20-5388701 NONE | Other services; Copying and duplicating; Direct payment from the plan Service code 36 | — | $9K |
| VSP EIN 35-6062367 NONE | Direct payment from the plan; Other services Service code 49 | — | $8K |
| DELANEY PRINTING COMPANY NONE | Direct payment from the plan; Copying and duplicating Service code 36 | 7045 CALUMET AVENUE HAMMOND, IN 46324 | $6K |
| TED WINDSOR & ASSOCIATES, LLC EIN 36-4374704 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $5K |
| AMALGAMATED BANK OF CHICAGO EIN 36-0721895 NONE | Direct payment from the plan; Custodial (securities); Investment management fees paid indirectly by plan Service code 19 | — | $2K |
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 | 444 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 201 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 645 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 403 | $21K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | PARTNER RE AMERICA INSURANCE COMPANY | 513 | $321K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 513 | — |
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.