| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STAEBLER GROUP5 Filed as: THE STAEBLER GROUP | 575 COPELAND MILL ROAD WESTERVILLE, OH 43081 | MEDICAL BENEFITS MUTUAL | $248 | — | $248 | 5.17% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MEDICAL BENEFITS ADMINISTRATORS EIN 31-1249371 CONTRACT | Plan Administrator Service code 14 | — | $30K |
| THE STAEBLER GROUP BROKER | Insurance agents and brokers Service code 22 | — | $25K |
| MEDICAL BENEFITS MUTUAL EIN 31-4210910 CONTRACT | Other fees Service code 99 | — | $13K |
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 | 94 | 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) | 94 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | MEDICAL BENEFITS MUTUAL | 94 | $5K |
| Stop-loss / reinsurancereinsurance | HCC BENEFITS | 94 | $323K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 94 | — |
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.