| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ONE SOURCE ADVISORS INC3 | 555 METRO PL N STE 480 DUBLIN, OH 43017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $11K | $4K | $14K | 16.37% |
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INS SERVICES | 2345 KING AVENUE WEST SUITE E BILLINGS, MT 59102 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $847 | $847 | 0.96% |
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS INC. | 555 METRO PL N STE 480 DUBLIN, OH 43017 | DELTA DENTAL OF OHIO | $2K | — | $2K | 4.66% |
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS INC. | 555 METRO PL N STE 480 DUBLIN, OH 43017 | VISION SERVICE PLAN | $818 | — | $818 | 6.84% |
| ONE SOURCE ADVISORS INC3 | 555 METRO PLACE, NORTH SUITE 480 DUBLIN, OH 43017 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $55 | — | $55 | 5.40% |
| PHILLIP EDWARD HOLSTEIN3 | 8559 HALLEY DRIVE DUBLIN, OH 43016 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $53 | — | $53 | 5.21% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | — | $38 | 3.73% |
| D STEVEN SMELCER3 | 7676 MEHAFFEY ROAD LIMA, OH 45801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 1.28% |
| LISA R CANFIELD3 Filed as: LISA CANFIELD | 324 STRAW COURT PATASKALA, OH 43062 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.69% |
| KAREN L VARGO3 Filed as: KAREN VARGO | 949 SHOREWOOD DRIVE FREEMONT, OH 43420 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.20% |
| DAVID L SMELCER3 | PO BOX 356 MAUMEE, OH 43537 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.20% |
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 | 103 | 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) | 103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 191 | $1.1M |
| Dental | DELTA DENTAL OF OHIO | 204 | $49K |
| Vision | VISION SERVICE PLAN | 83 | $12K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 137 | $88K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 137 | $88K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 137 | $88K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 137 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 204 | — |
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.