| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BAC AGENCY, INC.5 | 6331 EAST LIVINGSTON AVENUE REYNOLDSBURG, OH 43068 | UNITED HEALTHCARE | $4K | — | $4K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BUSINESS ADMINISTRATORS & CONS. INC THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | 6331 EAST LIVINGSTON AVENUE REYNOLDSBURG, OH 43068 | $124K |
| MEDICAL MUTUAL OF OHIO NETWORK PROVIDER | Insurance services Service code 23 | 2060 EAST 9TH STREET CLEVELAND, OH 44115 | $43K |
| BOB SIEKMANN INSURANCE AGENT | Insurance agents and brokers Service code 22 | 9000 MEMORIAL DRIVE PLAIN CITY, OH 43064 | $28K |
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 | 322 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 322 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIMERICA INSURANCE COMPANY | 261 | $366K |
| Life insurance | UNUM LIFE INSURANCE COMPANY | 322 | $91K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY | 322 | $91K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY | 322 | $91K |
| Prescription drug | UNIMERICA INSURANCE COMPANY | 261 | $366K |
| Stop-loss / reinsurancereinsurance | UNIMERICA INSURANCE COMPANY | 261 | $366K |
| Other(2 contracts, 2 carriers) | UNITED HEALTHCARE | 261 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 322 | — |
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.