| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KPM INSURANCE LLC | 76 MARCO LANE DAYTON, OH 45458 | ANTHEM LIFE INSURANCE COMPANY | $10K | $0 | $10K | 4.89% |
| CORNERSTONE BROKER INS SERVICES Filed as: CORNERSTONE BROKER INS SERV AGENCY | 2101 FLORENCE AVE CINCINNATI, OH 45206 | ANTHEM LIFE INSURANCE COMPANY | $6K | $0 | $6K | 3.00% |
| INTEGRATED EMPLOYEE BENEFIT SOLUTIO | 5880 VENTURE DRIVE DUBLIN, OH 43017 | COLONIAL LIFE & ACCIDENT INS COMPANY | $38 | — | $38 | 9.36% |
| INTEGRATED EMPLOYEE BENEFIT SOLUTIO Filed as: INTEGRATED BENEFIT COMMUNICATION SP | 5880 VENTURE DRIVE DUBLIN, OH 43017 | COLONIAL LIFE & ACCIDENT INS COMPANY | $5 | — | $5 | 1.23% |
| HOWARD B MESZAROS | 8680 COLVIN DRIVE PLAIN CITY, OH 43064 | COLONIAL LIFE & ACCIDENT INS COMPANY | $2 | — | $2 | 0.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX EIN 33-0441200 PHARMACY BENEFIT | Float revenue; Direct payment from the plan; Other fees; Claims processing Service code 12 | PO BOX 509075 SAN DIEGO, CA 92150 | $1.1M |
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | PO BOX 1087 WAUSAU, WI 54402 | $486K |
| KPM INSURANCE LLC EIN 27-1251252 BROKER | Other commissions Service code 55 | 61 MARCO LANE CENTERVILLE, OH 45458 | $50K |
| COTTINGHAM & BUTLER INS SRVS INC EIN 42-0198040 BROKER | Other commissions Service code 55 | 800 MAIN STREET DUBUQUE, IA 52001 | $30K |
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 | 1,378 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 1,378 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY | 1,376 | $196K |
| Short-term disability(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY | 1,376 | $196K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,376 | — |
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.