| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ONE SOURCE ADVISORS INC3 | 555 METRO PLACE N, SUITE 480 DUBLIN, OH 43017 | COMMUNITY INSURANCE COMPANY | — | $2K | $2K | 0.16% |
| ONE SOURCE ADVISORS INC3 | 555 METRO PL N STE 480 DUBLIN, OH 43017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $11K | — | $11K | 11.77% |
| LEAVITT GROUP3 Filed as: LEAVITT GREAT WEST INS SERVICES | 560 S 300 E, SUITE 150 SALT LAKE CITY, UT 84111 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $442 | $442 | 0.47% |
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS INC. | 555 METRO PL N STE 480 DUBLIN, OH 43017 | DELTA DENTAL OF OHIO | $3K | — | $3K | 4.77% |
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS INC. | 555 METRO PL N STE 480 DUBLIN, OH 43017 | VISION SERVICE PLAN | $855 | — | $855 | 6.59% |
| EMPLOYEE NAVIGATOR, LLC3 | 7979 OLD GEORGETOWN ROAD, SUITE 300 BETHESDA, MD 20814 | VISION SERVICE PLAN | $5 | — | $5 | 0.04% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $527 | — | $527 | 9.98% |
| ONE SOURCE ADVISORS INC3 | 555 METRO PLACE, NORTH SUITE 480 DUBLIN, OH 43017 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $341 | — | $341 | 6.46% |
| PHILLIP EDWARD HOLSTEIN3 | 8559 HALLEY DRIVE DUBLIN, OH 43016 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $67 | — | $67 | 1.27% |
| D STEVEN SMELCER3 | 7676 MEHAFFEY ROAD LIMA, OH 45801 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.32% |
| LISA R CANFIELD3 Filed as: LISA CANFIELD | 324 STRAW COURT PATASKALA, OH 43062 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.17% |
| KAREN L VARGO3 Filed as: KAREN VARGO | 949 SHOREWOOD DRIVE FREEMONT, OH 43420 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.06% |
| DAVID L SMELCER3 | PO BOX 356 MAUMEE, OH 43537 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.06% |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 172 | $1.0M |
| Dental | DELTA DENTAL OF OHIO | 185 | $54K |
| Vision | VISION SERVICE PLAN | 87 | $13K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 131 | $95K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 131 | $95K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 131 | $95K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 131 | $100K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 185 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.