| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MID ATLANTIC INSURANCE SERVICES LLC3 Filed as: MID-ATLANTIC INSURANCE SERVICES LLC | P O BOX 339 SANFORD, NC 27332 | DELTA DENTAL PLAN OF VIRGINIA | $4K | — | $4K | 4.98% |
| TOBY BLEVINS3 | P O BOX 847 MARION, VA 24354 | AMERICAN UNITED LIFE INSURANCE COMPANY | $2K | — | $2K | 8.92% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VIRGINIA, IN EIN 54-0357120 THIRD PARTY ADMINISTRATOR | Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | 1351 WM. HOWARD TAFT RD CINCINNATI, OH 45206 | $84K |
| MID ATLANTIC INSURANCE SERVICES LLC | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $36K |
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 | 151 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS OF VIRGINIA | 170 | $186K |
| Dental | DELTA DENTAL PLAN OF VIRGINIA | 267 | $73K |
| Vision | ANTHEM HEALTH PLANS OF VIRGINIA | 170 | $186K |
| Life insurance | AMERICAN UNITED LIFE INSURANCE COMPANY | 151 | $21K |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF VIRGINIA | 170 | $186K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 267 | — |
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.