| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HOLMES MURPHY & ASSOCIATES3 | 2727 GRAND PRAIRIE PARKWAY WAUKEE, IA 50263 | COMMUNITY INSURANCE COMPANY | $13K | — | $13K | 1.73% |
| NUB RUNOFF INC3 | 4151 EXECUTIVE PARKWAY, SUITE 340 WESTERVILLE, OH 43081 | COMMUNITY INSURANCE COMPANY | — | $998 | $998 | 0.13% |
| HOLMES MURPHY & ASSOCIATES3 | 2727 GRAND PRAIRIE PARKWAY WAUKEE, IA 50263 | AMERITAS LIFE INSURANCE CORP. | $2K | — | $2K | 1.92% |
| HOLMES MURPHY & ASSOCIATES3 | 2727 GRAND PRAIRIE PARKWAY WAUKEE, IA 50263 | ANTHEM LIFE INSURANCE COMPANY | $6K | — | $6K | 9.52% |
| NUB RUNOFF INC3 | 4151 EXECUTIVE PARKWAY, SUITE 340 WESTERVILLE, OH 43081 | ANTHEM LIFE INSURANCE COMPANY | — | $3K | $3K | 3.96% |
| HOLMES MURPHY & ASSOCIATES3 | 2727 GRAND PRAIRIE PARKWAY WAUKEE, IA 50263 | THE STANDARD | $2K | — | $2K | 51.49% |
| NUB RUNOFF INC3 | 4151 EXECUTIVE PARKWAY, SUITE 340 WESTERVILLE, OH 43081 | THE STANDARD | — | $813 | $813 | 21.42% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM LIFE INSURANCE COMPANY EIN 35-0980405 ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Float revenue; Claims processing Service code 12 | — | $3K |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 0 | $763K |
| Dental | AMERITAS LIFE INSURANCE CORP. | 0 | $119K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 0 | $119K |
| Life insurance(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY | 0 | $70K |
| Long-term disability(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY | 0 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 0 | — |
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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.