| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEARPATH BENEFIT ADVISORS LLC3 | 300 SPRUCE STREET SUITE 250 COLUMBUS, OH 43215 | COMMUNITY INSURANCE COMPANY | $24K | $1K | $25K | 2.55% |
| THE JAMES B OSWALD COMPANY3 | 1100 SUPERIOR AVENUE SUITE 1500 CLEVELAND, OH 44114 | COMMUNITY INSURANCE COMPANY | $0 | $11K | $11K | 1.09% |
| ERC SERVICES INC3 | 387 GOLF VIEW LANE STE 100 HIGHLAND HEIGHTS, OH 44143 | COMMUNITY INSURANCE COMPANY | $6K | $0 | $6K | 0.57% |
| CLEARPATH BENEFIT ADVISORS LLC3 | 300 SPRUCE STREET SUITE 250 COLUMBUS, OH 43215 | DELTA DENTAL OF OHIO | $4K | $0 | $4K | 4.57% |
| JEFFERY W JAMES3 | 1917 NEWARK GRANVILLE RD GRANVILLE, OH 43023 | NORTHWESTERN MUTUAL | $2K | $595 | $3K | 8.83% |
| KEMELGOR FNCL GRP INC3 | 800 YARD ST STE 300 COLUMBUS, OH 43212 | NORTHWESTERN MUTUAL | $472 | $57 | $529 | 1.58% |
| JEFFERY W JAMES3 | 1917 NEWARK GRANVILLE RD GRANVILLE, OH 43023 | NORTHWESTERN MUTUAL | $3K | $858 | $4K | 16.08% |
| KEMELGOR FNCL GRP INC3 | 800 YARD ST STE 300 COLUMBUS, OH 43212 | NORTHWESTERN MUTUAL | $681 | $82 | $763 | 2.88% |
| CLEARPATH BENEFIT ADVISORS LLC3 | 300 SPRUCE STREET SUITE 250 COLUMBUS, OH 43215 | AMERICAN UNITED LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ISOLVED BENEFITS SOLUTIONS CONTRACT | Plan Administrator Service code 14 | 15 E WASHINGTON STREET COLDWATER, MI 49036 | $4K |
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 | 106 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 90 | $982K |
| Dental | DELTA DENTAL OF OHIO | 275 | $82K |
| Life insurance | AMERICAN UNITED LIFE INSURANCE COMPANY | 106 | $24K |
| Short-term disability | NORTHWESTERN MUTUAL | 105 | $33K |
| Long-term disability | NORTHWESTERN MUTUAL | 77 | $27K |
| Other | AMERICAN UNITED LIFE INSURANCE COMPANY | 106 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 275 | — |
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.