| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN D PETTIGREW3 Filed as: JOHN HARDER | 463 OHIO PIKE CINCINNATI, OH 45255 | DELTA DENTAL | $6K | — | $6K | 2.99% |
| THE SCHELLER BRADFORD GROUP3 Filed as: SCHELLER BRADFORD GROUP | 463 OHIO PIKE CINCINNATI, OH 45255 | HARTFORD | $13K | — | $13K | 13.18% |
| THE SCHELLER BRADFORD GROUP3 Filed as: SCHELLER BRADFORD GROUP | 463 OHIO PIKE CINCINNATI, OH 45255 | EYEMED | $3K | — | $3K | 9.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $283K |
| SCHELLER BRADFORD EIN 31-1582334 BROKER | Other commissions Service code 55 | — | $0 |
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 | 255 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 258 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL | 624 | $206K |
| Vision | EYEMED | 435 | $31K |
| Life insurance | HARTFORD | 291 | $99K |
| Long-term disability | HARTFORD | 291 | $99K |
| Stop-loss / reinsurancereinsurance | UNITED HEALTH CARE | 616 | $316K |
| Other | HARTFORD | 291 | $99K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 624 | — |
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.