| 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 | $20K | — | $20K | 7.65% |
| OHIO AUTO DEALERS ASSN INS3 | ZACH DORAN 655 METRO PLACE SOUTH, STE 270 DUBLIN, OH 43017 | AMERICAN FIDELITY ASSURANCE COMPANY | — | $6K | $6K | 2.35% |
| LANG FINANCIAL GROUP, INC.3 | 4225 MALSBARY ROAD SUITE 100 CINCINNATI, OH 45242 | DENTAL CARE PLUS, INC. | $5K | — | $5K | 3.11% |
| LANG FINANCIAL GROUP, INC.3 | 4225 MALSBARY ROAD SUITE 100 CINCINNATI, OH 45242 | EYEMED | $2K | — | $2K | 9.12% |
| LANG FINANCIAL GROUP, INC.3 | 4225 MALSBARY ROAD SUITE 100 CINCINNATI, OH 45242 | AMERICAN UNITED LIFE INSURANCE COMPANY | $1K | — | $1K | 7.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NATIONAL UNDERWRITING SERVICES EIN 35-2481296 STOP/LOSS | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing Service code 12 | — | $268K |
| CUSTOM DESIGN BENEFITS, LLC EIN 81-0798821 CLAIMS PROCESSING | Claims processing Service code 12 | — | $138K |
| LANG FINANCIAL GROUP BROKER | Other commissions; Insurance brokerage commissions and fees Service code 53 | 4225 MALSBARY ROAD SUITE 100 CINCINNATI, OH 45242 | $77K |
| INNOVATIVE MEDICAL RISK EIN 45-4167263 PATIENT ADVOCATE | Contract Administrator; Other insurance fees and expenses; Insurance services Service code 13 | — | $12K |
| PAYER COMPASS EIN 46-2047081 CLAIMS REPRICER | Other services; Claims processing Service code 12 | — | $9K |
| RX RESULTS EIN 26-3233073 PRESCRIPTION AUTHORIZATIO | Contract Administrator; Other services Service code 13 | — | $8K |
| THE PHIA GROUP EIN 46-1439866 OTHER | Other services; Consulting fees Service code 49 | — | $4K |
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 | 482 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 489 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DENTAL CARE PLUS, INC. | 483 | $148K |
| Vision | EYEMED | 394 | $24K |
| Life insurance | AMERICAN UNITED LIFE INSURANCE COMPANY | 482 | $14K |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 155 | $261K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 155 | $261K |
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 317 | $267K |
| Other(2 contracts, 2 carriers) | AMERICAN FIDELITY ASSURANCE COMPANY | 482 | $275K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 483 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.