| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EUGENE J. ROSSI3 | 701 FAIRWAY DRIVE NE WARREN, OH 44483 | GUARDIAN LIFE INSURACE CO. OF AMERICA | $12K | $4K | $16K | 9.67% |
| EUGENE J. ROSSI3 Filed as: EUGENE JEFFREY ROSSI | 201 EAST COMMERCE STREET STE 337 YOUNGSTOWN, OH 44503 | GEISINGER QUALITY OPTIONS, INC. | $555 | $15 | $570 | 1.38% |
| EUGENE J. ROSSI3 | 201 EAST COMMERCE STREET STE 337 YOUNGSTOWN, OH 44503 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $627 | — | $627 | 8.11% |
| EUGENE J. ROSSI3 | P.O. BOX 630 WARREN, OH 44482 | COMMUNITY INSURANCE COMPANY, DBA ANTHEM BLUE CROSS & BLUE SHIELD | $0 | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $103K |
| E.J. ROSSI & COMPANY EIN 27-7541595 BROKER | Other commissions Service code 55 | 201 E. COMMERCE STREET SUITE 33 YOUNGSTOWN, OH 44503 | $36K |
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Float revenue; Claims processing Service code 12 | — | $24K |
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 | 307 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 307 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GEISINGER QUALITY OPTIONS, INC. | 18 | $41K |
| Dental | GUARDIAN LIFE INSURACE CO. OF AMERICA | 313 | $169K |
| Vision | GUARDIAN LIFE INSURACE CO. OF AMERICA | 313 | $169K |
| Life insurance | GUARDIAN LIFE INSURACE CO. OF AMERICA | 313 | $169K |
| Short-term disability | GUARDIAN LIFE INSURACE CO. OF AMERICA | 313 | $169K |
| Long-term disability | GUARDIAN LIFE INSURACE CO. OF AMERICA | 313 | $169K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | HCC LIFE INSURANCE COMPANY | 224 | $234K |
| Other(2 contracts, 2 carriers) | GUARDIAN LIFE INSURACE CO. OF AMERICA | 313 | $177K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 313 | — |
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.