| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBISA REACQUISITION CORP3 | 2101 FLORENCE AVENUE CINCINNATI, OH 45206 | AETNA LIFE INSURANCE COMPANY | $16K | — | $16K | 1.43% |
| PHELAN INSURANCE AGENCY, INC.3 Filed as: PHELAN INSURANCE AGENCY INC | PO BOX 1 VERSAILLES, OH 45380 | PRINCIPAL LIFE INSURANCE COMPANY | $13K | $4K | $17K | 11.74% |
| CORNERSTONE BROKER INS SERVICES3 Filed as: CORNERSTONE BROKER INS. SERVICE | 2101 FLORENCE AVE CINCINNATI, OH 45206 | PRINCIPAL LIFE INSURANCE COMPANY | — | $6K | $6K | 4.02% |
| CASH IN LLC3 | 8636 CHESHIRE COURT FRANKLIN, OH 45005 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $580 | — | $580 | 3.82% |
| LUKE MURRAY3 | 8793 OAK VILLAGE BLVD LEWIS CENTER, OH 43035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $207 | $6 | $213 | 1.40% |
| JAMES D SAMS3 | 239 FENWAY ROAD COLUMBUS, OH 43214 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $173 | — | $173 | 1.14% |
| JASON ROSS RUBINSTEIN3 | 2076 BENTWOOD CIR-APT 2B COLUMBUS, OH 43235 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $115 | — | $115 | 0.76% |
| KIM EDWARD KELLY3 Filed as: KIM E KELLY | 10156 MALLET DR DAYTON, OH 45458 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $52 | — | $52 | 0.34% |
| HOWARD MESZAROS3 | 8680 COLVIN DRIVE PLAIN CITY, OH 43064 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.13% |
| CASH IN LLC3 | 8636 CHESHIRE COURT FRANKIN, OH 45005 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $108 | — | $108 | 3.05% |
| LUKE MURRAY3 | 8793 OAKVILLAGE BLVD LEWIS CENTER, OH 43035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $53 | — | $53 | 1.50% |
| JASON ROSS RUBINSTEIN3 | 2076 BENTWOOD CIRCLE - APT 2B COLUMBUS, OH 43235 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 0.73% |
| JAMES D SAMS3 | 239 FENWAY ROAD COLUMBUS, OH 43214 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.14% |
| KIM EDWARD KELLY3 Filed as: KIM E KELLY | 10156 MALLET DRIVE DAYTON, OH 45458 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.08% |
| HOWARD MESZAROS3 | 8680 COLVIN DRIVE PLAIN CITY, OH 43064 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.08% |
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 | 105 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 216 | $1.1M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 179 | $148K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 179 | $148K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 179 | $152K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 179 | $148K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 179 | $148K |
| Other(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 25 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 216 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.