| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCASCIO HADDEN & DENNIS LLC3 | 10585 N MERIDIAN ST STE 275 INDIANAPOLIS, IN 46290 | ANTHEM INSURANCE COMPANIES, INC. | $0 | $13K | $13K | 0.86% |
| ICUL SERVICES CORPORATION3 | 5975 CASTLE CREEK PKWY N DRIVE SUITE 200 INDIANAPOLIS, IN 46250 | DELTA DENTAL OF INDIANA | $45K | — | $45K | 4.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 TPA | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Float revenue; Other fees; Claims processing; Other services Service code 12 | — | $1.5M |
| ICUL SERVICES CORPORATION EIN 35-6065923 PLAN MANAGER | Participant communication; Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Direct payment from the plan; Accounting (including auditing); Copying and duplicating Service code 10 | — | $450K |
| LHD BENEFIT ADVISORS EIN 35-2150902 ADVISOR | Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Recordkeeping fees; Direct payment from the plan; Account maintenance fees Service code 15 | — | $197K |
| BOSE, MCKINNEY, & EVANS, LLP EIN 35-0957980 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $110K |
| ANTHEM BLUE CROSS/BLUE SHIELD EIN 35-0781558 EAP | Other services; Direct payment from the plan Service code 49 | — | $45K |
| FAEGRE BAKER DANIELS LLP EIN 41-0244008 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $36K |
| THE HOWARD E NYHART COMPANY, INC EIN 35-0966414 ACTUARY | Direct payment from the plan; Actuarial Service code 11 | — | $15K |
| BRADY WARE AND SCHOENFELD EIN 35-1476702 AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $14K |
| CC LAW & POLICY PLLC EIN 16-1662980 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $5K |
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 | 2,325 | 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) | 2,325 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF INDIANA | 2,844 | $898K |
| Vision | ANTHEM INSURANCE COMPANIES, INC. | 2,325 | $1.5M |
| Life insurance | ANTHEM INSURANCE COMPANIES, INC. | 2,325 | $1.5M |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. | 2,325 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,844 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.