| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE INDEMNITY GROUP LLC3 Filed as: THE INDEMNITY GROUP | 3737 PARK EAST DR. STE 204 BEACHWOOD, OH 44122 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $101K | $101K | 2.25% |
| MARK J. SAMAR3 | 31755 FAIRMONT BLVD. PEPPER PIKE, OH 44124 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $35K | — | $35K | 5.72% |
| THE INDEMNITY GROUP LLC3 Filed as: THE INDEMNITY GROUP, LLC | 3628 WALNUT HILLS RD. STE 200 BEACHWOOD, OH 44122 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $16K | $16K | 2.60% |
No Schedule C service providers reported on this filing.
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 | 860 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 861 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 508 | $4.5M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 899 | $611K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 899 | $611K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 899 | $611K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 899 | $611K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 899 | $611K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 899 | $611K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 899 | — |
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.