| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 10 NORTH PARK DR SUITE 200 HUNT VALLEY, MD 21030 | SUN LIFE ASSURANCE COMPANY OF CANADA | $21K | — | $21K | 1.84% |
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 10 N PARK DR STE 200 HUNT VALLEY, MD 21030 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $65K | — | $65K | 21.55% |
| IMG3 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $106 | $106 | 0.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VIRGINIA EIN 54-0357120 HEALTH PPO/DENTAL ADMIN | Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Float revenue; Claims processing Service code 12 | — | $158K |
| HEALTHJOY EIN 46-5722012 TPA | Contract Administrator; Claims processing Service code 12 | — | $34K |
| HEALTHCHECK360 WELLNESS TPA FEES | Claims processing; Contract Administrator Service code 12 | 800 MAIN STREET DUBUQUE, IA 52001 | $30K |
| HEALTHKEEPERS, INC. EIN 54-1356687 HEALTH INDEMNITY ADMIN | Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Claims processing; Other services Service code 12 | — | $16K |
| WEX EIN 01-0526993 FSA ADMIN | Claims processing; Contract Administrator Service code 12 | — | $6K |
| INGENIORX, INC. EIN 82-3062245 RX ADMIN | Float revenue; Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator 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 | 552 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 562 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 476 | $53K |
| Dental | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 476 | $53K |
| Vision | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 476 | $53K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 552 | $302K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 552 | $302K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 552 | $302K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 427 | $1.2M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 552 | $328K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 552 | — |
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.