| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELTY ASSURANCE COMPANY | PO BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $30K | — | $30K | 5.09% |
| OHIO AUTO DEALERS ASSN INS3 | ZACH DORAN 655 METRO PLACE SOUTH, STE 270 DUBLIN, OH 43017 | AMERICAN FIDELITY ASSURANCE COMPANY | — | $12K | $12K | 2.03% |
| LANG FINANCIAL GROUP, INC.3 | 4225 MALSBARY ROAD SUITE 100 CINCINNATI, OH 45242 | DELTA DENTAL OF OHIO | $5K | — | $5K | 3.18% |
| LANG FINANCIAL GROUP, INC.3 | 4225 MALSBARY ROAD SUITE 100 CINCINNATI, OH 45242 | EYEMED | $3K | — | $3K | 9.16% |
| LANG FINANCIAL GROUP, INC.3 | 4225 MALSBARY ROAD SUITE 100 CINCINNATI, OH 45242 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 9.26% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NATIONAL UNDERWRITING SERVICES EIN 35-2481296 STOP/LOSS | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | — | $317K |
| CUSTOM DESIGN BENEFITS, LLC EIN 81-0798821 CLAIMS PROCESSING | Claims processing Service code 12 | — | $165K |
| LANG FINANCIAL GROUP BROKER | Other commissions; Insurance brokerage commissions and fees Service code 53 | 4225 MALSBARY ROAD SUITE 100 CINCINNATI, OH 45242 | $83K |
| PAYER COMPASS EIN 46-2047081 CLAIMS REPRICER | Other services; Claims processing Service code 12 | — | $14K |
| RX RESULTS EIN 26-3233073 PRESCRIPTION AUTHORIZATIO | Contract Administrator; Other services Service code 13 | — | $10K |
| INNOVATIVE MEDICAL RISK EIN 45-4167263 PATIENT ADVOCATE | Other insurance fees and expenses; Insurance services; Contract Administrator Service code 13 | — | $8K |
| THE PHIA GROUP EIN 46-1439866 OTHER | Other services; Consulting fees Service code 49 | — | $6K |
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 | 530 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 530 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AMERICAN FIDELITY ASSURANCE COMPANY | 230 | $584K |
| Dental | DELTA DENTAL OF OHIO | 602 | $167K |
| Vision | EYEMED | 503 | $33K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 530 | $20K |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 230 | $584K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 230 | $584K |
| Other(2 contracts, 2 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 530 | $604K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 602 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.