| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALTHANS INSURANCE AGENCY INC3 | PO BOX 570 CHAGRIN FALLS, OH 44022 | MEDICAL MUTUAL OF OHIO | $25K | $1K | $26K | 3.47% |
| ACRISURE LLC3 Filed as: LBW INSURANCE & FINANCIAL SERVICES, | 28055 SMYTH DRIVE VALENCIA, CA 91355 | HEALTH NET | $6K | $26 | $6K | 6.02% |
| UPSHAW INSURANCE AGENCY INC.3 Filed as: UPSHAW INSURANCE AGENCY INC | PO BOX 1299 AMARILLO, TX 79105 | ALL SAVERS INSURANCE COMPANY | $3K | — | $3K | 10.92% |
| ALTHANS INSURANCE AGENCY INC3 Filed as: ALTHANS INSURANCE AGENCY | 543 EAST WASHINGTON STREET CHAGRIN FALLS, OH 44022 | ANTHEM LIFE INSURANCE COMPANY | $1K | — | $1K | 5.03% |
| ALTHANS INSURANCE AGENCY INC3 Filed as: ALTHANS INSURANCE AGENCY | 543 EAST WASHINGTON STREET CHAGRIN FALLS, OH 44022 | ANTHEM LIFE INSURANCE COMPANY | $2K | — | $2K | 6.62% |
| ALTHANS INSURANCE AGENCY INC3 Filed as: ALTHANS INSURANCE AGENCY | 543 EAST WASHINGTON STREET CHAGRIN FALLS, OH 44022 | ANTHEM LIFE INSURANCE COMPANY | $2K | — | $2K | 10.48% |
| ALTHANS INSURANCE AGENCY INC3 Filed as: ALTHANS INSURANCE AGENCY | 543 EAST WASHINGTON STREET CHAGRIN FALLS, OH 44022 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $3K | — | $3K | 18.95% |
| ACRISURE LLC3 Filed as: LBW INS & FINANCIAL SER | 28055 SMYTH DRIVE VALENCIA, CA 91355 | HUMANA INSURANCE COMPANY | $1K | $236 | $1K | 11.12% |
| UPSHAW INSURANCE AGENCY INC.3 Filed as: UPSHAW INSURANCE AGENCY | 801 SOUTH FILLMORE STREET SUITE 300 AMARILLO, TX 79101 | PRINCIPAL LIFE INSURANCE COMPANY | $494 | $57 | $551 | 11.91% |
| ACRISURE LLC3 Filed as: LBW INS & FINANCIAL SER | 28055 SMYTH DRIVE VALENCIA, CA 91355 | HUMANADENTAL INSURANCE COMPANY | $51 | $64 | $115 | 18.73% |
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 | 128 | 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) | 129 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | MEDICAL MUTUAL OF OHIO | 59 | $860K |
| Dental(4 contracts, 4 carriers) | MEDICAL MUTUAL OF OHIO | 59 | $773K |
| Vision(3 contracts, 3 carriers) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 128 | $32K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 130 | $22K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 130 | $26K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 130 | $25K |
| Prescription drug | MEDICAL MUTUAL OF OHIO | 59 | $755K |
| Stop-loss / reinsurancereinsurance | ALL SAVERS INSURANCE COMPANY | 9 | $26K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 130 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 130 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.