| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | THE GUARDIAN LIFE INSURANCE COMPANY | $1K | $4K | $5K | 8.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 1111 SUPERIOR AVENUE EAST SUITE 1601 CLEVELAND, OH 44114 | THE GUARDIAN LIFE INSURANCE COMPANY | $3K | $0 | $3K | 4.37% |
| JAMES A BURRESS3 Filed as: JAMES BURRESS AND OTHER AGENTS | 64118 FAYBOROUGH COURT DUBLIN, OH 43016 | AFLAC | $812 | $6 | $818 | 4.75% |
| PEOPLES INSURANCE AGENCY, LLC3 | 124 PUTNAM STREET P.O. BOX 210 JACKSON, OH 45640 | AFLAC | $671 | $0 | $671 | 3.90% |
| KIMBERLY NIETO3 | 5419 CLUB DRIVE WESTERVILLE, OH 43082 | AFLAC | $579 | $38 | $617 | 3.59% |
| ERIC BLAHA3 | 1103 SCHROCK ROAD COLUMBUS, OH 43229 | AFLAC | $382 | $0 | $382 | 2.22% |
| MICHAEL RIST7 | 4814 MEDALLION DR W WESTERVILLE, OH 43082 | AFLAC | $253 | $71 | $324 | 1.88% |
| DONNA LIVINGSTON3 | 402 HANSEGEN MORGAN ROAD WHEELERSBURG, OH 45694 | AFLAC | $252 | $0 | $252 | 1.46% |
| HENSLEY AND ASSOCIATES LLC3 Filed as: HENSLEY AND ASSOCIATES | 1103 SCHROCK RD SUITE 201 COLUMBUS, OH 43229 | AFLAC | $223 | $19 | $242 | 1.41% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | THE GUARDIAN LIFE INSURANCE COMPANY | $582 | $762 | $1K | 11.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 1111 SUPERIOR AVENUE EAST SUITE 1601 CLEVELAND, OH 44114 | THE GUARDIAN LIFE INSURANCE COMPANY | $604 | $0 | $604 | 5.09% |
| PEOPLES INSURANCE AGENCY, LLC3 | DBA BARENGO INSURANCE P.O. BOX 210 MARIETTA, OH 45750 | AMERICAN HERITAGE LIFE (ALLSTATE) | $661 | $0 | $661 | 6.19% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | THE GUARDIAN LIFE INSURANCE COMPANY | $441 | $620 | $1K | 11.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 1111 SUPERIOR AVENUE EAST SUITE 1601 CLEVELAND, OH 44114 | THE GUARDIAN LIFE INSURANCE COMPANY | $449 | $0 | $449 | 5.05% |
| BAC AGENCY, INC.5 | 6331 EAST LIVINGSTON AVENUE REYNOLDSBURG, OH 43068 | UNITED HEALTHCARE INSURANCE COMPANY | $805 | $0 | $805 | 10.00% |
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 | 203 | 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) | 203 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNIMERICA INSURANCE COMPANY | 82 | $212K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY | 116 | $58K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY | 116 | $58K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY | 203 | $23K |
| Short-term disability(3 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY | 203 | $31K |
| Prescription drug | UNIMERICA INSURANCE COMPANY | 82 | $202K |
| Stop-loss / reinsurancereinsurance | UNIMERICA INSURANCE COMPANY | 82 | $202K |
| Other(2 contracts, 2 carriers) | AFLAC | 82 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 203 | — |
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.