| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GREG STOCKSDALE3 | P. O. BOX 32 URBANA, OH 43078 | AMERICAN UNITED LIFE INSURANCE COMPANY | $8K | — | $8K | 7.28% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLASCAK INSURANCE SERVICES, LLC EIN 47-1663993 NONE | Insurance agents and brokers Service code 22 | 7262 BRUNDAGE RD. WALDO, OH 43356 | $144K |
| MEDICAL BENEFITS ADMINSTRATORS, INC EIN 31-1249371 NONE | Plan Administrator Service code 14 | 1975 TAMARACK RD NEWARK, OH 43055 | $105K |
| OHIO HEALTH CHOICE, INC. EIN 34-1895396 NONE | Other fees Service code 99 | 1077 GEORGE BOULEVARD AKRON, OH 44310 | $40K |
| ZELIS EIN 31-1407689 NONE | Other fees Service code 99 | PO BOX 743856 ATLANTA, GA 30374 | $24K |
| PAYER COMPASS EIN 46-2047081 NONE | Other fees Service code 99 | 5800 GRANITE PARKWAY, SUITE 450 PLANO, TX 75024 | $11K |
| MEDICAL BENEFITS MUTUAL LIFE INS EIN 31-4210910 NONE | Plan Administrator Service code 14 | 1975 TAMARACK RD NEWARK, OH 43055 | $7K |
| HINES & ASSOCIATES, INC. EIN 36-3545085 NONE | Other fees Service code 99 | 115 E. HIGHLAND AVE. ELGIN, IL 60120 | $7K |
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 | 297 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 297 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMERICAN UNITED LIFE INSURANCE COMPANY | 297 | $105K |
| Stop-loss / reinsurancereinsurance | CENTERSTONE INSURANCE AND FINANCIAL SERVICES | 297 | $465K |
| Other(2 contracts, 2 carriers) | AMERICAN UNITED LIFE INSURANCE COMPANY | 297 | $150K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 297 | — |
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.