| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS INC. | 555 METRO PLACE, N, #480 DUBLIN, OH 43017 | SUN LIFE ASSURANCE COMPANY OF CANADA | $52K | — | $52K | 15.00% |
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS, INC. | 555 METRO PLACE NORTH, #330 DUBLIN, OH 43017 | HARTFORD LIFE AND ACCIDENT | $7K | — | $7K | 15.00% |
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS, INC. | — | DELTA DENTAL OF PENNSYLVANIA | $2K | — | $2K | 5.00% |
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS, INC. | 555 METRO PLACE NORTH, #480 DUBLIN, OH 43017 | NATIONAL VISION ADMINISTRATORS, LLC | $509 | — | $509 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK, INC. EIN 23-1294723 PROVIDER | Contract Administrator; Other fees; Claims processing Service code 12 | — | $39K |
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 | 122 | 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) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 139 | $40K |
| Vision | NATIONAL VISION ADMINISTRATORS, LLC | 131 | $10K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 117 | $49K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 117 | $49K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 90 | $344K |
| Other | HARTFORD LIFE AND ACCIDENT | 117 | $49K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 139 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.