| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE JAMES B OSWALD COMPANY Filed as: JAMES B OSWALD COMPANY | 1100 SUPERIOR AVE SUITE 1500 CLEVELAND, OH 44114 | HCC LIFE INSURANCE COMPANY | $20K | — | $20K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 CLAIMS ADMINISTRATOR | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Other services; Claims processing Service code 12 | — | $317K |
| HCC LIFE INSURANCE COMPANY EIN 35-1817054 STOP LOSS INSURANCE | Insurance services Service code 23 | 225 TOWNPARK DR 350 KENNESAW, GA 30144 | $204K |
| CIGNA EIN 06-0303370 CLAIMS PROCESSOR | Non-monetary compensation; Float revenue; Participant communication; Direct payment from the plan; Named fiduciary; Claims processing; Contract Administrator; Other services Service code 12 | 3500 PIEDMONT RD STE 200 ATLANTA, GA 30305 | $108K |
| BENESYS, INC. EIN 34-1787882 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 33 FITCH BLVD AUSTINTOWN, OH 44515 | $59K |
| ENVISION PHARMACEUTICAL SERVICES EIN 05-0570786 CLAIMS PROCESSOR | Claims processing Service code 12 | 2181 E AURORA RD STE 201 TWINSBURG, OH 44087 | $35K |
| LEDBETTER PARISI SOLLARS LLC EIN 03-0599899 ATTORNEY | Legal Service code 29 | 9240 MARKET PLACE DRIVE MIAMISBURG, OH 45342 | $35K |
| MOSIER AND ASSOCIATES CPAS INC EIN 47-1912410 AUDITOR | Accounting (including auditing) Service code 10 | 180 E SPRING VALLEY B CENTERVILLE, OH 45458 | $25K |
| UNITED ACTUARIAL SERVICES INC EIN 35-2156428 ACTUARY | Actuarial Service code 11 | 11590 N MERIDAN ST 610 CARMEL, IN 460324529 | $9K |
| FIFTH THIRD BANK EIN 31-1051736 INVESTMENT CUSTODIAN | Custodial (securities) Service code 19 | 38 FOUNTAIN SQUARE PLAZA CINCINNATI, OH 45263 | $9K |
| ARTHUR J GALLAGHER & CO EIN 36-2102482 LIABILITY INSURANCE | Insurance agents and brokers Service code 22 | 1 W FOURTH ST SUITE 1300 CINCINNATI, OH 45202 | $8K |
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 | 625 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 133 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 758 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA | 136 | $71K |
| Vision | EYEMED VISION CARE | 1,833 | $35K |
| Prescription drug | ENVISION PHARMACEUTICAL SERVICES LLC | 1,856 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,856 | — |
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.