| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ICUL SERVICES CORPORATION3 | 5975 CASTLE CREEK PKWY N DRIVE SUITE 200 INDIANAPOLIS, IN 46250 | DELTA DENTAL OF INDIANA | $101K | — | $101K | 5.99% |
| ICUL SERVICES CORPORATION3 | 5975 CASTLE CREEK PARKWAY N DRIVE SUITE 200 INDIANAPOLIS, IN 46250 | VISION SERVICE PLAN | $39K | — | $39K | 10.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 TPA | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Float revenue; Other fees; Contract Administrator Service code 12 | — | $2.5M |
| ICUL SERVICES CORPORATION EIN 35-6065923 PLAN MANAGER | Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Accounting (including auditing); Participant communication; Copying and duplicating; Direct payment from the plan Service code 10 | — | $750K |
| LHD BENEFIT ADVISORS EIN 35-2150902 ADVISOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Recordkeeping fees; Account maintenance fees; Consulting (general); Direct payment from the plan Service code 15 | — | $359K |
| INGENIORX, INC EIN 82-3062245 PHARMACY | Float revenue; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $83K |
| ANTHEM BLUE CROSS/BLUE SHIELD EIN 35-0781558 EAP | Direct payment from the plan; Other services Service code 49 | — | $67K |
| INDIANA CREDIT UNION LEAGUE EIN 35-0408785 ADVOCACY | Consulting (general) Service code 16 | — | $63K |
| KENTUCKY CREDIT UNION LEAGUE EIN 61-0391408 ADVOCACY | Consulting (general) Service code 16 | — | $25K |
| BOSE, MCKINNEY, & EVANS, LLP EIN 35-0957980 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $25K |
| BMI AUDIT SERVICES HOLDINGS, LLC EIN 38-4091484 CLAIMS AUDITOR | Other services Service code 49 | — | $24K |
| BRADY, WARE AND SCHOENFELD EIN 35-1476702 AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $14K |
| RSC INSURANCE BROKERAGE EIN 16-1689464 INSURANCE AGENT | Insurance agents and brokers; Insurance services Service code 22 | — | $11K |
| THE HOWARD E NYHART COMPANY, INC EIN 35-0966414 ACTUARY | Actuarial; Direct payment from the plan Service code 11 | — | $6K |
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 | 3,537 | 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) | 3,537 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF INDIANA | 5,109 | $1.7M |
| Vision(2 contracts, 2 carriers) | ANTHEM INSURANCE COMPANIES, INC. | 3,537 | $2.1M |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. | 3,537 | $1.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,109 | — |
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.