| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THOMAS STAEBLER3 Filed as: THOMAS H STAEBLER | 575 COPELAND MILL RD 2D WESTERVILLE, OH 43081 | COMMUNITY INSURANCE COMPANY | $25K | — | $25K | 7.06% |
| NATIONAL UNITED BROKERS3 Filed as: NATIONAL UNITED BROKERS INC | 4151 EXECUTIVE PKWY 210 WESTERVILLE, OH 43081 | COMMUNITY INSURANCE COMPANY | — | $189 | $189 | 0.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 | Claims processing; Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $191K |
| THOMAS H STAEBLER | Non-monetary compensation; Other commissions; Insurance agents and brokers Service code 22 | 575 COPELAND MILL RD 2D WESTERVILLE, OH 43081 | $25K |
| NATIONAL UNITED BROKERS INC | Other commissions; Non-monetary compensation; Trustee (directed) Service code 25 | 4151 EXECUTIVE PKWY 210 WESTERVILLE, OH 43081 | $189 |
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 | 175 | 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) | 175 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY | 175 | $358K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 175 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.