| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HALLIE HAKAIM3 | 285 COZZINS ST COLUMBUS, OH 43215 | DELTA DENTAL OF OHIO | $22K | — | $22K | 9.29% |
| KURA, MICHAEL R3 | 2735 CRAWFIS BLVD STE 200 FAIRLAWN, OH 44333 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 6.03% |
| REDMOND, JAMES E3 | 2735 CRAWFIS BLVD STE 200 FAIRLAWN, OH 44333 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 2.58% |
| KURA, MICHAEL R3 | 2735 CRAWFIS BLVD STE 200 FAIRLAWN, OH 44333 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $15K | — | $15K | 14.82% |
| REDMOND, JAMES E3 | 2735 CRAWFIS BLVD STE 200 FAIRLAWN, OH 44333 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 6.35% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF OHIO LLC | 3900 KINROSS LAKES PKWY STE 300 RICHFIELD, OH 44286 | UNITEDHEALTHCARE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| AP BENEFIT ADVISORS, LLC3 Filed as: AP BENEFIT ADVISORS LLC | 200 INTERNATIONAL CIRCLE HUNT VALLEY, MD 21031 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $158 | $158 | 0.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $280K |
| ASSUREDPARTNERS OF OHIO LLC EIN 80-0786940 BROKER | Other commissions Service code 55 | — | $132K |
| UNUM LIFE INSURANCE COMPANY OF AMER EIN 01-0278678 ADMIN FOR STD | Claims processing; Contract Administrator Service code 12 | — | $7K |
| EXPRESS SCRIPTS, INC. EIN 43-1420563 RX ADMIN | Contract Administrator; Claims processing Service code 12 | — | $1K |
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 | 358 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 360 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 305 | $28K |
| Dental | DELTA DENTAL OF OHIO | 645 | $241K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 358 | $122K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 358 | $122K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 346 | $343K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 358 | $220K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 645 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.