| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 | 4500 TOWN CENTER BOULEVARD SUITE 200 JEFFERSONVILLE, IN 47130 | ANTHEM HEALTH PLANS OF KENTUCKY, INC. | $46K | $126 | $46K | 3.50% |
| MJ INSURANCE3 Filed as: STEPHEN GODFREY AND VARIOUS AGENTS | 363 LOMBARDY DRIVE CECILIA, KY 42724 | AFLAC | $8K | $435 | $8K | 7.81% |
| ASSUREDPARTNERS3 | 5905 EAST GALBRAITH ROAD SUITE 5000 CINCINNATI, OH 45236 | AFLAC | $6K | $0 | $6K | 5.98% |
| PAMELA ROWSEY LARSON3 | 844 SANDSTONE RIDGE COLD SPRING, KY 41076 | AFLAC | $3K | $48 | $3K | 3.14% |
| DEBRA SMART3 | 605 AUTUMN WOOD DRIVE RICHMOND, KY 40475 | AFLAC | $1K | $83 | $1K | 1.35% |
| LAWRENCE TODD FUGATE3 | 2352 HARTLAND PARKSIDE DRIVE LEXINGTON, KY 40515 | AFLAC | $1K | $21 | $1K | 1.34% |
| DAVID LUURTSEMA3 | 308 ROSEDALE DRIVE ELIZABETHTOWN, KY 42701 | AFLAC | $1K | $38 | $1K | 0.96% |
| MIGUEL ROMAN3 | 1401 LA FONTENAY COURT LOUISVILLE, KY 40223 | AFLAC | $894 | $0 | $894 | 0.82% |
| ASSUREDPARTNERS3 | 2305 RIVER ROAD LOUISVILLE, KY 40206 | DELTA DENTAL OF KENTUCKY | $5K | $0 | $5K | 9.23% |
| ASSUREDPARTNERS3 | 4500 TOWN CENTER BOULEVARD SUITE 200 JEFFERSONVILLE, IN 47130 | ANTHEM LIFE INSURANCE COMPANY | $276 | $1 | $277 | 3.50% |
No Schedule C service providers reported on this filing.
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 | 346 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 346 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS OF KENTUCKY, INC. | 356 | $1.3M |
| Dental | DELTA DENTAL OF KENTUCKY | 184 | $50K |
| Vision | ANTHEM HEALTH PLANS OF KENTUCKY, INC. | 356 | $1.3M |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 0 | $8K |
| Prescription drug | ANTHEM HEALTH PLANS OF KENTUCKY, INC. | 356 | $1.3M |
| Other(2 contracts, 2 carriers) | AFLAC | 144 | $116K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 356 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.