| 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 | $10K | — | $10K | 12.38% |
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS INC. | 555 METRO PL N STE 480 DUBLIN, OH 43017 | DELTA DENTAL OF OHIO | $2K | $113 | $3K | 4.95% |
| ONE SOURCE ADVISORS INC3 Filed as: ONE SOURCE ADVISORS INC. | 555 METRO PL N STE 480 DUBLIN, OH 43017 | VISION SERVICE PLAN | $928 | — | $928 | 6.65% |
| ONE SOURCE ADVISORS INC3 | 555 METRO PLACE, NORTH SUITE 480 DUBLIN, OH 43017 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $80 | — | $80 | 1.92% |
| PHILLIP EDWARD HOLSTEIN3 | 5976 PENNINGTON CREEK DRIVE DUBLIN, OH 43016 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $74 | — | $74 | 1.78% |
| JUSTIN J MCDONALD3 | 12052 PEPPERMILL LANE PICKERINGTON, OH 43147 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $37 | — | $37 | 0.89% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | — | $36 | 0.86% |
| ANDREA BETH HOLSTEIN3 | 5976 PENNINGTON CREEK DRIVE DUBLIN, OH 43016 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.34% |
| KAREN L VARGO3 Filed as: KAREN VARGO | 949 SHOREWOOD DRIVE FREEMONT, OH 43420 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.07% |
| PHILLIP P SMITH3 Filed as: PHILLIP SMITH | 2378 TUCKER TRAIL LEWIS CENTER, OH 43035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.05% |
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 | 145 | 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) | 145 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 216 | $1.1M |
| Dental | DELTA DENTAL OF OHIO | 228 | $51K |
| Vision | VISION SERVICE PLAN | 98 | $14K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 145 | $82K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 145 | $82K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 145 | $82K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 145 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 228 | — |
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.