| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHERI GILLFILLAN3 | 555 METRO PLACE N, SUITE 480 DUBLIN, OH 43017 | DELTA DENTAL OF OHIO | $11K | — | $11K | 9.13% |
| ONE SOURCE ADVISORS INC3 | 555 METRO PLACE N, SUITE 480 DUBLIN, OH 43017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $1K | $12K | 16.77% |
| 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 | — | $611 | $611 | 0.89% |
| ONE SOURCE ADVISORS INC3 | 555 METRO PLACE N, SUITE 480 DUBLIN, OH 43017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $555 | $6K | 16.66% |
| 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 | — | $278 | $278 | 0.83% |
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS | 555 METRO PLACE N, SUITE 480 DUBLIN, OH 43017 | VISION SERVICE PLAN | $970 | — | $970 | 6.00% |
| ONE SOURCE ADVISORS INC3 | 555 METRO PLACE N, SUITE 480 DUBLIN, OH 43017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $835 | $101 | $936 | 16.82% |
| 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 | — | $51 | $51 | 0.92% |
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 | 113 | 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) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 288 | $1.4M |
| Dental | DELTA DENTAL OF OHIO | 288 | $125K |
| Vision | VISION SERVICE PLAN | 100 | $16K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $34K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $6K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $69K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $34K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 288 | — |
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.