| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PREFERRED BENEFITS SERVICES AGENCY3 Filed as: PREFERRED BENEFIT SERVICES AGENCY | PO BOX 868 DELAWARE, OH 43015 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $673 | $5K | 5.83% |
| PREFERRED BENEFITS SERVICES AGENCY3 Filed as: PREFERRED BENEFIT SERVICES AGENCY | PO BOX 868 DELAWARE, OH 43015 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $6K | $595 | $7K | 16.41% |
| PREFERRED BENEFITS SERVICES AGENCY3 | PO BOX 868 DELAWARE, OH 43015 | FIDELITY SECURITY LIFE INSURANCE COMPANY (EYEMED) | $3K | $0 | $3K | 9.85% |
| PREFERRED BENEFITS SERVICES AGENCY3 Filed as: PREFERRED BENEFIT SERVICES AGENCY | PO BOX 868 DELAWARE, OH 43015 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $289 | $1K | 6.41% |
| PREFERRED BENEFITS SERVICES AGENCY3 Filed as: PREFERRED BENEFIT SERVICES AGENCY | PO BOX 868 DELAWARE, OH 43015 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | $238 | $3K | 16.42% |
| PREFERRED BENEFITS SERVICES AGENCY3 Filed as: PREFERRED BENEFIT SERVICES AGENCY | PO BOX 868 DELAWARE, OH 43015 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $163 | $1K | 17.03% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 NONE | Claims processing; Contract Administrator; Other fees; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $104K |
| PREFERRED BENEFITS SERVICES AGENCY NONE | Insurance brokerage commissions and fees; Other commissions; Insurance agents and brokers Service code 22 | PO BOX 868 DELAWARE, OH 43015 | $39K |
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 | 214 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 214 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 175 | $81K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY (EYEMED) | 269 | $28K |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 214 | $25K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 190 | $42K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 190 | $20K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY | 220 | $237K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 64 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 269 | — |
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.