| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HYLANT GROUP INC3 Filed as: HYLANT GROUP | 811 MADISON AVE TOLEDO, OH 43604 | ARDELLIS INSURANCE LTD | $109K | — | $109K | 13.13% |
| MEDICAL MUTUAL OF OHIO0 | 2060 E. 9TH STREET CLEVELAND, OH 44115 | ARDELLIS INSURANCE LTD | — | $30K | $30K | 3.58% |
| MEDWATCH LLC0 | PO BOX 952679 LAKE MARY, FL 32795 | ARDELLIS INSURANCE LTD | — | $5K | $5K | 0.59% |
| TELE DOC0 | 100 FEDERAL STREET 21ST FLOOR BOSTON, MA 02110 | ARDELLIS INSURANCE LTD | — | $4K | $4K | 0.47% |
| SAGAMORE HEALTH NETWORK0 | 11595 N. MERIDIAN STREET SUITE 600 CARMEL, IN 46032 | ARDELLIS INSURANCE LTD | — | $2K | $2K | 0.26% |
| MEDAI DATA MINING0 | 4901 VINELAND ROAD ORLANDO, FL 32811 | ARDELLIS INSURANCE LTD | — | $1K | $1K | 0.16% |
| COFINITY0 | 28588 NORTHWESTERN HWY SUITE 380 SOUTHFIELD, MI 48034 | ARDELLIS INSURANCE LTD | — | $276 | $276 | 0.03% |
| HYLANT GROUP INC3 Filed as: HYLANT GROUP, INC. | 811 MADISON AVE TOLEDO, OH 43604 | DELTA DENTAL | $12K | — | $12K | 9.97% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | $603 | $6K | 14.40% |
| HYLANT GROUP INC3 Filed as: HYLANT GROUP, INC | PO BOX 1687 TOLEDO, OH 436061687 | EYEMED | $2K | — | $2K | 10.04% |
| HYLANT GROUP INC3 Filed as: HYLANT GROUP, INC. | PO BOX 1687 TOLEDO, OH 43603 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $180 | $2K | 14.40% |
| HYLANT GROUP INC3 Filed as: HYLANT GROUP, INC | 811 MADISON AVE TOLEDO, OH 43604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $648 | $76 | $724 | 14.54% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT ASSISTANCE CORPORATION EIN 55-0715869 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | PO BOX 950 HURRICANE, WV 14228 | $89K |
| TRUE RX MANAGEMENT SERVICES, INC EIN 26-0502364 PBM | Claims processing Service code 12 | PO BOX 431 2495 E. NATIONAL HWY WASHINGTON, IN 47501 | $20K |
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 | 193 | 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) | 193 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL | 355 | $119K |
| Vision | EYEMED | 444 | $22K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 29 | $43K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 20 | $13K |
| Stop-loss / reinsurancereinsurance | ARDELLIS INSURANCE LTD | 193 | $829K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 26 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 444 | — |
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.