| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 312 ELM STREET, 24TH FLOOR CINCINNATI, OH 45202 | MEDICAL MUTUAL | $38K | $10K | $49K | 3.38% |
| PIERSANTE AND ASSOCIATES, INC.3 | 230 RUSSO DRIVE CANFIELD, OH 44406 | COMMUNITY INSURANCE COMPANY | $623 | $0 | $623 | 0.73% |
| USI INSURANCE SERVICES LLC3 | 222 SOUTH RIVERSIDE PLAZA SUITE 900 CHICAGO, IL 60606 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $154 | $2K | 10.93% |
| KATHRYN ROMANO,3 | 146 GLENSHIRE LANE MEDINA, OH 44256 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 9.04% |
| WILLIAM T. WALBORN3 | 10701 OBEE ROAD WHITEHOUSE, OH 43571 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $118 | $0 | $118 | 0.97% |
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 | 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)(3 contracts, 3 carriers) | MEDICAL MUTUAL | 89 | $1.5M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 63 | $17K |
| Vision | MEDICAL MUTUAL | 89 | $1.4M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 121 | $12K |
| Prescription drug(3 contracts, 3 carriers) | MEDICAL MUTUAL | 89 | $1.5M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 121 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 121 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.