| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OHIO BENEFIT GROUP, LLC.3 | 900 CROGHAN STREET FREEMONT, OH 43420 | SUMMACARE | $28K | — | $28K | 3.29% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 200 SUMMIT LAKE DRIVE, SUITE 350 VALHALLA, NY 10595 | SUMMACARE | $4K | — | $4K | 0.49% |
| OHIO AUTO DEALERS ASSN INS3 Filed as: OHIO HEALTH BENEFITS, LLC | 30-B NW AVENUE, SUITE 110 TALLMADGE, OH 44278 | HUMANA INSURANCE COMPANY | $5K | $484 | $5K | 5.95% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 3733 PARK EAST DRIVE, SUITE 250 BEACHWOOD, OH 44122 | HUMANA INSURANCE COMPANY | $560 | — | $560 | 0.62% |
| OHIO AUTO DEALERS ASSN INS3 Filed as: OHIO HEALTH BENEFITS, LLC | 30-B NW AVENUE, SUITE 110 TALLMADGE, OH 44278 | KANAWHA INSURANCE COMPANY | $3K | $104 | $3K | 12.20% |
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 | 112 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SUMMACARE | 264 | $861K |
| Dental | HUMANA INSURANCE COMPANY | 112 | $91K |
| Life insurance | HUMANA INSURANCE COMPANY | 112 | $91K |
| Short-term disability | KANAWHA INSURANCE COMPANY | 110 | $28K |
| Long-term disability | KANAWHA INSURANCE COMPANY | 110 | $28K |
| Prescription drug | SUMMACARE | 264 | $861K |
| Other | HUMANA INSURANCE COMPANY | 112 | $91K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 264 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.