| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BRS GROUP LTD | 3988 MILES AVENUE NW CANTON, OH 44718 | LIFE INSURANCE COMPANY OF NORTH AMERICA(3) | $4K | — | $4K | 0.93% |
| BRS GROUP LTD3 | MILES AVENUE NW CANTON, OH 44718 | COMMUNITY INSURANCE COMPANY(4) | $4K | — | $4K | 5.00% |
| ANTHONY JOSEPH MOTTER Filed as: ANTHONY M LLOYD INC | 1910 INDIANWOOD CIRCLE MAUMEE, OH 43537 | ALLSTATE BENEFITS | $4K | — | $4K | 10.53% |
| BRS GROUP LTD | 3988 MILES AVENUE NW CANTON, OH 44718 | ALLSTATE BENEFITS | $4K | — | $4K | 9.71% |
| BRS GROUP LTD Filed as: BRS GROUP LTS | 3988 MILES AVENUE NW CANTON, OH 44718 | LIFE INSURANCE COMPANY OF NORTH AMERICA(1) | $2K | — | $2K | 8.95% |
| ANTHONY JOSEPH MOTTER Filed as: ANTHONY LLOYD | 1205 LOUISIANA AVENUE PERRYSBURGE, OH 43552 | ALLSTATE BENEFITS | $4K | — | $4K | 16.22% |
| BENEFIT RELATED SERVICES Filed as: BENEFIT RELATED SERVICES GROUP LTS | 3988 MILES AVENUE NW CANTON, OH 44718 | ALLSTATE BENEFITS | $4K | — | $4K | 15.09% |
| BRS GROUP LTD | 3988 MILES AVENUE NW CANTON, OH 44718 | LIFE INSURANCE COMPANY OF NORTH AMERICA(2) | $180 | — | $180 | 5.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 ADMINISTRATIVE SERVICES | Insurance agents and brokers; Other commissions; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing; Insurance brokerage commissions and fees Service code 12 | — | $179K |
| NETWORK PHARMACY EIN 31-1714795 NETWORK PHARMACY MARGIN | Other fees Service code 99 | — | $10K |
| EXPRESS SCRIPTS INC EIN 31-1440175 PRESCRIPTION DRUGS | Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 13 | — | $0 |
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 | 400 | 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) | 400 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | ALLSTATE BENEFITS | 77 | $62K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA(3) | 400 | $398K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA(2) | 400 | $4K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA(1) | 400 | $28K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY(4) | 400 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 400 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.