| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY3 | 1300 EAST NINTH STREET, SUITE 1900 CLEVELAND, OH 441141593 | THE UNION LABOR LIFE INSURANCE COMPANY | $28K | — | $28K | 6.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE CO. DBA ANTHEM EIN 31-1440175 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $506K |
| SEGAL COMPANY MIDWEST EIN 13-1975125 NONE | Insurance brokerage commissions and fees; Actuarial; Direct payment from the plan; Consulting (general) Service code 11 | — | $123K |
| SEI INVESTMENTS MANAGEMENT CORP EIN 04-2452803 NONE | Investment advisory (plan); Investment management; Direct payment from the plan Service code 27 | — | $95K |
| FINANCIAL ADMINISTRATOR EIN 31-6035546 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $70K |
| PLAN ADMINISTRATOR EIN 31-6035546 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $65K |
| VORYS SATER SEYMOUR & PEASE EIN 31-4333125 NONE | Legal; Direct payment from the plan Service code 29 | — | $55K |
| FRUSH & ASSOCIATES INC. EIN 31-1308134 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $49K |
| CONTRIBUTIONS COORDINATOR EIN 31-6035546 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $45K |
| DELTA DENTAL EIN 31-0685339 NONE | Contract Administrator; Claims processing; Direct payment from the plan Service code 12 | — | $32K |
| ELIGIBILITY&ENROLLMENT COORDINATOR EIN 31-6035546 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $30K |
| EXECUTIVE SEARCH PARTNERS EIN 27-1716988 NONE | Direct payment from the plan; Other services Service code 49 | — | $22K |
| BYRNE SOFTWARE TECHNOLOGIES, INC. EIN 43-1853340 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $13K |
| PITNEY BOWES INC. NONE | Direct payment from the plan; Other services Service code 49 | 3001 SUMMER ST. STAMFORD, CT 06926 | $12K |
| SEGAL SELECT INSURANCE EIN 46-0619194 NONE | Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $8K |
| SEI PRIVATE TRUST CO. EIN 23-3060382 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $6K |
| COMDOC, INC. EIN 34-0813593 NONE | Direct payment from the plan; Other services Service code 49 | — | $6K |
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 | 694 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 396 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,090 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | ANTHEM BLUE CROSS BLUE SHIELD | 268 | $384K |
| Vision | VISION SERVICE PLAN | 939 | $148K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 1,362 | $300K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 765 | $403K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 1,362 | $300K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,362 | — |
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.