| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PLANCORP VANTAGE BENEFIT ADVISORS Filed as: PLANCORP/VANTAGE BENEFIT ADVISORS | 6200 ROCKSIDE ROAD #100 CLEVELAND, OH 44131 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $234 | $65 | $299 | 19.13% |
| LIFETIME FINANCIAL GROWTH | 25101 CHAGRIN BLVD SUITE 100 BEACHWOOD, OH 44122 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2 | — | $2 | 0.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NATIONWIDE CHILDRENS HOSP EIN 31-4379441 NONE | Employee (plan) Service code 30 | — | $183K |
| ENVISION PHARMACEUTICAL SERVICES EIN 05-0570786 NONE | Employee (plan) Service code 30 | — | $104K |
| DAYTON CHILDRENS HOSPITAL EIN 31-0672132 NONE | Employee (plan) Service code 30 | — | $102K |
| NATIONWIDE CHILDRENS HOSPITAL EIN 31-1024403 NONE | Employee (plan) Service code 30 | — | $82K |
| SUBRAMANYA RAO EIN 80-0239468 NONE | Employee (plan) Service code 30 | — | $72K |
| PALOS COMMUNITY HOSPITAL EIN 36-2169179 NONE | Employee (plan) Service code 30 | — | $57K |
| SUMMA HEALTH SYSTEM EIN 34-0714755 NONE | Employee (plan) Service code 30 | — | $35K |
| OHIO STATE UNIVERSITY EIN 31-1340739 NONE | Employee (plan) Service code 30 | — | $35K |
| THE J.P. FARLEY CORPORATION EIN 34-1363719 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | — | $32K |
| KOEHLER NEAL, LLC EIN 27-4209347 NONE | Employee (plan) Service code 30 | — | $31K |
| CHILDRENS HOSPITAL MEDICAL CENTER EIN 34-0714357 NONE | Employee (plan) Service code 30 | — | $25K |
| MIAMI VALLEY HOSPITAL EIN 31-0537504 NONE | Employee (plan) Service code 30 | — | $18K |
| FRANCISCAN ST. JAMES EIN 36-2167869 NONE | Employee (plan) Service code 30 | — | $15K |
| MEDWATCH, LLC EIN 16-1662117 NONE | Employee (plan) Service code 30 | — | $9K |
| NORTHWESTERN MEMORIAL HOSPITAL EIN 36-3097297 NONE | Employee (plan) Service code 30 | — | $9K |
| RIVERVIEW HEALTH INSTITUTE EIN 76-0734987 NONE | Employee (plan) Service code 30 | — | $8K |
| MERCY HOSPITAL FAIRFIELD EIN 31-0538532 NONE | Employee (plan) Service code 30 | — | $8K |
| FORT HAMILTON REHABILITATION CENTER EIN 31-0536662 NONE | Employee (plan) Service code 30 | — | $7K |
| CRYSTAL CLINIC ORTHOPAEDIC EIN 26-1136049 NONE | Employee (plan) Service code 30 | — | $5K |
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 | 74 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 74 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 75 | $2K |
| Stop-loss / reinsurancereinsurance | SIRIUS AMERICA INSURANCE COMPANY | 66 | $47K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 75 | — |
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.