| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INDIANA CHAMBER INSURANCE AGENCY3 Filed as: INDIANA STATE MEDICAL ASSOC | — | ANTHEM INSURANCE COMPANIES, INC. (G2001) | $419 | — | $419 | 0.11% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF INDIANA LLC | — | ANTHEM INSURANCE COMPANIES, INC. (G2001) | $11 | — | $11 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 NONE | Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator Service code 12 | — | $318K |
| INDIANA STATE MEDICAL ASSOC INS AGY EIN 35-1731389 NONE | Insurance services Service code 23 | — | $118K |
| LHD BENEFIT ADVISORS EIN 35-2150902 NONE | Other fees Service code 99 | — | $68K |
| BOSE, MCKINNEY & EVANS LLP EIN 35-0957980 NONE | Legal; Accounting (including auditing) Service code 10 | — | $64K |
| MILLIMAN, INC EIN 35-1427161 NONE | Actuarial Service code 11 | — | $63K |
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 | 882 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 891 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. (G2001) | 1,865 | $380K |
| Dental | ANTHEM INSURANCE COMPANIES, INC. (G2001) | 1,865 | $380K |
| Vision | ANTHEM INSURANCE COMPANIES, INC. (G2001) | 1,865 | $380K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. (G2001) | 1,865 | $380K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,865 | — |
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.
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.