| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KPM INSURANCE LLC | 76 MARCO LANE CENTERVILLE, OH 45458 | ANTHEM BLUE CROSS BLUE SHIELD | $10K | — | $10K | 5.38% |
| CORNERSTONE BROKER INS SERVICES Filed as: CORNERSTONE BROKER INS SERVICES AG | 2101 FLORANCE AVE CINCINNATI, OH 45206 | ANTHEM BLUE CROSS BLUE SHIELD | — | $9K | $9K | 5.02% |
| INTEGRATED EMPLOYEE BENEFIT SOLUTIO | 10589 LAGUNA CIRC PLAIN CITY, OH 43064 | COLONIAL LIFE & ACCIDENT INS COMP | $28 | — | $28 | 6.57% |
| HOWARD B MESZAROS | 8680 COLVIN DRIVE PLAIN CITY, OH 43064 | COLONIAL LIFE & ACCIDENT INS COMP | $2 | — | $2 | 0.47% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PHARMACY BENEFIT MANAGEME | Float revenue; Claims processing; Direct payment from the plan; Other fees Service code 12 | P.O. BOX 650629 DALLAS, TX 75265 | $1.3M |
| UMR EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | P.O. BOX 1087 WAUSAU, WI 54402 | $146K |
| KPM INSURANCE LLC EIN 27-1251252 BROKER | Other commissions Service code 55 | 76 MARCO LN CENTERVILLE, OH 45458 | $42K |
| COTTINGHAM & BUTLER INS SRVCS INC. EIN 42-0198040 BROKER | Other commissions Service code 55 | 800 MAIN STREET DUBUQUE, IA 52001 | $25K |
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 | 804 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 804 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM BLUE CROSS BLUE SHIELD | 804 | $182K |
| Short-term disability(2 contracts, 2 carriers) | ANTHEM BLUE CROSS BLUE SHIELD | 804 | $183K |
| Stop-loss / reinsurancereinsurance | UNITED HEALTHCARE INSURANCE COMPANY | 804 | $259K |
| Other | UNITED HEALTHCARE INSURANCE COMPANY | 804 | $259K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 804 | — |
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."
No prospect flags tripped on this filing.