| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY | 1111 SUPERIOR AVE, SUITE 2340 CLEVELAND, OH 44114 | THE UNION LABOR LIFE INSURANCE COMPANY | $8K | — | $8K | 1.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM, INC. CLAIMS PROCESSOR | Claims processing Service code 12 | 120 MONUMENT CIRCLE INDIANAPOLIS, IN 46204 | $418K |
| BENESYS INC THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | 3660 STUTZ DRIVE, STE 101 330-270-0453 CANFIELD, OH 44406 | $205K |
| MAHONING, TRUMBULL AND SHENAGO VALL COLLECTION AGENCY | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 3660 STUTZ DRIVE, STE 101 CANFIELD, OH 44406 | $60K |
| THE SEGAL COMPANY EIN 13-1975125 MEDICAL CONSULTANT | Consulting (general) Service code 16 | 1300 EAST 9TH STREET CLEVELAND, OH 441141593 | $51K |
| FAULKNER, HOFFMAN & PHILLIPS ATTORNEY | Legal Service code 29 | 20445 EMERALD PKWY 210 CLEVELAND, OH 44135 | $23K |
| PNC BANK EIN 36-4142114 BANK SERVICE CHARGES | Direct payment from the plan; Recordkeeping fees Service code 50 | — | $18K |
| PARAMOUNT PREFERRED SOLUTIONS CLAIMS MANAGEMENT | Claims processing Service code 12 | P.O. BOX 72131 CLEVELAND, OH 441920002 | $16K |
| AND CO. CONSULTING INVESTMENT CONSULTANT | Consulting (general) Service code 16 | 4901 VINELAND RD SUITE 60 ORLANDO, FL 32811 | $15K |
| YURCHYK & DAVIS CPA'S INC EIN 34-1638235 AUDITOR | Accounting (including auditing) Service code 10 | — | $15K |
| AMERICAN GRAPHICS PRINTING CO PRINTING SERVICES | Copying and duplicating Service code 36 | 34895 GROESBECK HWY CLINTON TWP, MI 48035 | $13K |
| FIFTH THIRD BANK RETIREMENT SERVICE EIN 31-1051736 CUSTODIAN | Custodial (securities) Service code 19 | — | $11K |
| PARSONS RISK STRATEGIES, LLC ACTUARY | Actuarial Service code 11 | 347 TIMBERLAKE DRIVE AVON LAKE, OH 44012 | $6K |
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 | 929 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 99 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,028 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 1,027 | $580K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,028 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.