| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | 5450 FRANTZ RD, SUITE 300 DUBLIN, OH 43016 | SUPERIOR DENTAL CARE, INC | — | $78 | $78 | 0.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MUTUAL HEALTH SERVICES EIN 34-0648820 THIRD PARTY VENDOR | Insurance services Service code 23 | 3636 COPLEY ROAD, SUITE 201 COPLEY, OH 44321 | $183K |
| JACKSON, DIEKEN AND ASSOCIATES EIN 34-1718397 D & O INSURANCE | Insurance services Service code 23 | 27893 CLEMENS ROAD, SUITE 1 WESTLAKE, OH 441451169 | $73K |
| QUELINE CONSULTING EIN 85-1309340 PLAN ADMINISTRATION | Employee (plan) Service code 30 | 4507 CHASELINE RIDGE BRUNSWICK, OH 44212 | $59K |
| CBIZ EMPLOYEE BENEFITS EIN 22-2769024 BROKER | Insurance brokerage commissions and fees Service code 53 | 300 EAST ESPLANADE DRIVE, SUITE 250 OXNARD, CA 93036 | $57K |
| SAMARITAN FUND EIN 87-3467536 CLAIMS ADMINISTRATION | Claims processing Service code 12 | 3121 21ST STREET METAIRIE, LA 70002 | $55K |
| EIDE BAILLY LLP EIN 45-0250958 AUDITOR | Accounting (including auditing); Other services Service code 10 | PO BOX 2545 FARGO, ND 58108 | $15K |
| CENTRAL DATA SERVICES, INC. EIN 25-1352803 ELIGIBILITY VENDOR | Other services Service code 49 | 5 HOT METAL STREET, SUITE 200 PITTSBURGH, PA 152032351 | $14K |
| CALL A DOCTOR EIN 46-1682881 TELADOC | Other services Service code 49 | 35 NOD ROAD, SUITE 102 AVON, CT 06001 | $14K |
| PARSONS RISK STRATEGIES EIN 26-6885036 RESEARCH VENDOR | Insurance services Service code 23 | 347 TIMBERLANE DR AVON LAKE, OH 44012 | $8K |
| LPFG, LLC EIN 27-1504224 ACCOUNTANT | Accounting (including auditing) Service code 10 | 36901 AMERICAN WAY SUITE 7 AVON, OH 44011 | $7K |
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 | 29 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 135 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 29 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 193 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY | 251 | $612K |
| Dental | SUPERIOR DENTAL CARE, INC | 192 | $115K |
| Stop-loss / reinsurancereinsurance | STANDARD LIFE AND ACCIDENT INSURANCE COMPANY | 273 | $174K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 273 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.