| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SERVICE | P.O. BOX 63286 CINCINNATI, OH 45263 | SUPERIOR DENTAL CARE, INC | $71 | — | $71 | 0.07% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF OHIO LLC | 3900 KINROSS LAKES PARKWAY, STE. 30 RICHFIELD, OH 44286 | SUPERIOR DENTAL CARE, INC | $1 | — | $1 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CETERA ADVISOR NETWORKS, LLC EIN 30-0588666 INVESTMENT MANAGER | Investment management Service code 28 | P.O. BOX 293 ST. CLOUD, MN 56301 | $118K |
| 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 COUNSULTING EIN 85-1309340 PLAN ADMINISTRATION | Employee (plan) Service code 30 | 4507 CHASELINE RIDGE BRUNSWICK, OH 44212 | $53K |
| ASSURED PARTNERS, LLC EIN 80-0786940 BROKER | Insurance brokerage commissions and fees Service code 53 | 3900 KENROSS LAKES PKWY #300 RICHFIELD, OH 442869445 | $32K |
| CENTRAL DATA SERVICES, INC. EIN 25-1352803 ELIGIBILITY VENDOR | Other services Service code 49 | — | $14K |
| APPLE GROWTH PARTNERS EIN 34-1082617 AUDITOR | Other services; Accounting (including auditing) Service code 10 | 1540 W MARKET STREET AKRON, OH 44313 | $14K |
| CALL A DOCTOR PLUS EIN 46-1682881 MOBILE HEALTHCARE | Contract Administrator Service code 13 | — | $14K |
| PARSONS RISK STRATEGIES EIN 26-6885036 RESEARCH VENDOR | Insurance services Service code 23 | — | $12K |
| MUTUAL HEALTH SERVICES EIN 34-0648820 THIRD PARTY ADMINISTRATI | Contract Administrator Service code 13 | P.O. BOX 5700 CLEVELAND, OH 44101 | $10K |
| CBIZ EMPLOYEE BENEFITS EIN 22-2769024 BROKER | Insurance brokerage commissions and fees Service code 53 | 300 EAST ESPLANADE DRIVE, SUITE 250 OXNARD, CA 93036 | $9K |
| LPFG, LLC EIN 27-1504224 ACCOUNTANT | Accounting (including auditing) Service code 10 | 503 ABBE ROAD, SOUTH ELYRIA, OH 440356301 | $5K |
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 | 40 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 194 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 234 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA INSURANCE COMPANY | 271 | $594K |
| Dental | SUPERIOR DENTAL CARE, INC | 191 | $103K |
| Vision | SUPERIOR DENTAL CARE, INC | 191 | $103K |
| Prescription drug | HUMANA INSURANCE COMPANY | 271 | $594K |
| Stop-loss / reinsurancereinsurance | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS | 13 | $202K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 271 | — |
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."
No prospect flags tripped on this filing.