| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INNOVATIVE INSURANCE GROUP LLC3 | 2670 ELECTRIC RD ROANOKE, VA 24018 | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | — | — | $0 | 0.00% |
| INNOVATIVE INSURANCE GROUP LLC3 | 2670 ELECTRIC RD ROANOKE, VA 24018 | DELTA DENTAL OF VIRGINIA | $5K | — | $5K | 6.56% |
| INNOVATIVE INSURANCE GROUP LLC3 | 2670 ELECTRIC RD ROANOKE, VA 24018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $435 | $5K | 19.57% |
| INNOVATIVE INSURANCE GROUP LLC3 | 2670 ELECTRIC RD ROANOKE, VA 24018 | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | $1K | $414 | $2K | 12.99% |
| INNOVATIVE INSURANCE GROUP LLC3 | 2670 ELECTRIC RD ROANOKE, VA 24018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $219 | $3K | 19.66% |
| INNOVATIVE INSURANCE GROUP LLC3 | 2670 ELECTRIC RD ROANOKE, VA 24018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $175 | $2K | 19.67% |
| INNOVATIVE INSURANCE GROUP LLC3 | 2670 ELECTRIC RD ROANOKE, VA 24018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 18.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VIRGINIA EIN 54-0357120 CARRIER | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Float revenue; Contract Administrator Service code 12 | 3075 VANDERCAR WAY CINCINNATI, OH 45209 | $51K |
| INNOVATIVE INSURANCE GROUP LLC | Non-monetary compensation; Other commissions; Insurance agents and brokers Service code 22 | — | $29K |
| HEALTHKEEPERS INC | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator; Float revenue Service code 12 | — | $26K |
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 | 125 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF VIRGINIA | 181 | $82K |
| Vision | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | 191 | $14K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 125 | $10K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 125 | $21K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 125 | $28K |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF VIRGINIA DBA ANTHEM BCBS | 110 | $256K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 191 | — |
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.