| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS, INC. | 555 METRO PLACE N, SUITE 480 DUBLIN, OH 43017 | DELTA DENTAL OF OHIO | $15K | — | $15K | 9.87% |
| ONE SOURCE ADVISORS INC3 | 555 METRO PLACE N, SUITE 480 DUBLIN, OH 43017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | $3K | $15K | 18.83% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP INSURANCE ADVISORS | 560 S 300 E, SUITE 150 SALT LAKE CITY, UT 84111 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $690 | $690 | 0.85% |
| ONE SOURCE ADVISORS INC3 | 555 METRO PLACE N, SUITE 480 DUBLIN, OH 43017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $7K | 19.17% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP INSURANCE ADVISORS | 560 S 300 E, SUITE 150 SALT LAKE CITY, UT 84111 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $340 | $340 | 0.93% |
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS | 555 METRO PLACE N, SUITE 480 DUBLIN, OH 43017 | VISION SERVICE PLAN | $1K | — | $1K | 5.70% |
| ONE SOURCE ADVISORS INC3 | 555 METRO PLACE N, SUITE 480 DUBLIN, OH 43017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $947 | $250 | $1K | 18.96% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP INSURANCE ADVISORS | 560 S 300 E, SUITE 150 SALT LAKE CITY, UT 84111 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $56 | $56 | 0.89% |
No Schedule C service providers reported on this filing.
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 | 129 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 320 | $1.5M |
| Dental | DELTA DENTAL OF OHIO | 321 | $152K |
| Vision | VISION SERVICE PLAN | 117 | $18K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 128 | $37K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 128 | $6K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 128 | $81K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 128 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 321 | — |
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.