| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SAMAR, MARK Filed as: SAMAR FINANCIAL GROUP INC | 3628 WALNUT HILLS RD 200 BEACHWOOD, OH 44122 | ANTHEM - COMMUNITY INSURANCE COMPANY | $290 | — | $290 | 3.36% |
| THE INDEMNITY GROUP LLC Filed as: INDEMNITY GROUP LLC | 3628 WALNUT HILLS RD 200 ORANGE VILLAGE, OH 44122 | ANTHEM - COMMUNITY INSURANCE COMPANY | $144 | — | $144 | 1.67% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MAUREEN STAVOLE EMPLOYEE | Employee (plan) Service code 30 | 6051 CAREY DRIVE VALLEY VIEW, OH 441254259 | $72K |
| GARY BONCELLA THIRD PARTY ADMINISTRATOR | Employee (plan) Service code 30 | 6051 CAREY DRIVE VALLEY VIEW, OH 441254259 | $72K |
| CHRISSANN CHAMBERS EMPLOYEE | Employee (plan) Service code 30 | 6051 CAREY DRIVE VALLEY VIEW, OH 441254259 | $65K |
| LOCAL UNION 436 RENT | Other fees Service code 99 | 6051 CAREY DRIVE VALLEY VIEW, OH 441254259 | $49K |
| ZENITH AMERICAN SOLUTIONS THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | 302 KNIGHTS RUN AVE TAMPA, FL 33602 | $15K |
| YURCHYK & DAVIS CPA'S AUDITOR | Accounting (including auditing) Service code 10 | 3660 STUTZ DRIVE, STE 101 CANFIELD, OH 44406 | $15K |
| THE SEGAL COMPANY EIN 13-1975125 ACTUARY | Actuarial Service code 11 | 1111 SUPERIOR AVE CLEVELAND, OH 44114 | $14K |
| FAULKNER, HOFFMAN & PHILLIPS LLC ATTORNEY | Legal Service code 29 | 20445 EMERALD PKWY DR CLEVELAND, OH 44135 | $8K |
| PAYCHEX, INC. PAYROLL SERVICES | Accounting (including auditing) Service code 10 | 5080 TUTTLE CROSSING BLVD DUBLIN, OH 43016 | $8K |
| QUADIENT FINANCE USA, INC. POSTAGE PROVIDER | Other fees Service code 99 | 1 SOUTH WACKER DR CHICAGO, IL 60606 | $8K |
| ISSI SOFTWARE SOLUTIONS COMPUTER CONSULTING | Consulting (general) Service code 16 | 3000 SOUTH LENOLA RD MAPLE SHADE, NJ 08052 | $7K |
| IRON MOUNTAIN STORAGE | Other fees Service code 99 | 1101 ENTERPRISE DR ROYERSFORD, PA 19468 | $5K |
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 | 145 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 68 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 213 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CLEVELAND BAKERS & TEAMSTERS H&W FUND | 213 | $2.5M |
| Dental | ANTHEM - COMMUNITY INSURANCE COMPANY | 213 | $9K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 213 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 213 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.