No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MEDICAL MUTUAL SERVICES EIN 34-1922587 CLAIMS ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | 2060 EAST 9TH STREET CLEVELAND, OH 44115 | $97K |
| AMERICAN BENEFIT CORPORATION EIN 55-0672859 THIRD PARTY ADMINISTRATOR | Recordkeeping fees; Direct payment from the plan; Contract Administrator; Consulting (general); Claims processing Service code 12 | 9200 US ROUTE 60 ONA, WV 25545 | $88K |
| ALLOTTA, FARLEY & CO., LPA EIN 34-1316963 ATTORNEY | Legal; Direct payment from the plan Service code 29 | 3240 LEVIS COMMONS BLVD. PERRYSBURG, OH 43551 | $63K |
| SEGAL CONSULTING EIN 13-1975125 CONSULTANT, ACTUARY | Actuarial; Accounting (including auditing); Direct payment from the plan Service code 10 | 101 N WACKER DR, STE 500 CHICAGO, IL 60606 | $56K |
| DENISE MANN EIN 23-7404076 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | P.O. BOX 638 NORWALK, OH 44857 | $54K |
| PAYNE NICKLES & CO. EIN 34-1664586 AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | 257 BENEDICT AVE, BLDG D NORWALK, OH 44857 | $32K |
| PNC BANK EIN 22-1146430 INVESTMENT MANAGER | Accounting (including auditing); Investment advisory (plan); Investment management fees paid indirectly by plan; Trustee (bank, trust company, or similar financial institution) Service code 10 | 1900 E 9TH STREET CLEVELAND, OH 44114 | $18K |
| COSTCO HEALTH SOLUTIONS, INC. EIN 81-2865195 ADMINISTRATIVE SERVICES | Claims processing; Direct payment from the plan; Recordkeeping fees Service code 12 | 999 LAKE DRIVE ISSAQUAH, WA 98027 | $10K |
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 | 189 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 112 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 13 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 314 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | MEDICAL MUTUAL OF OHIO | 710 | $455K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 710 | — |
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.
Filing reports zero broker compensation on a plan over 100 participants. Likely direct-write or unreported — worth a knock.