| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROOKS INSURANCE AGENCY3 | 1120 MADISON AVE TOLEDO, OH 43604 | DELTA DENTAL OF OHIO | $2K | — | $2K | 1.89% |
| BROOK INSURANCE AGENCY INC3 | 1120 MADISON AVE. TOLEDO, OH 43604 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $1K | — | $1K | 3.61% |
| BROOK INSURANCE AGENCY INC3 | 1120 MADISON AVE TOLEDO, OH 43604 | ANTHEM LIFE INSURANCE COMPANY | $1K | — | $1K | 9.30% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 NOT RELATED | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Claims processing; Contract Administrator; Float revenue; Other services Service code 12 | 4361 IRWIN SIMPSON ROAD MASON, OH 45040 | $310K |
| BROOKS INSURANCE AGENCY | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | — | $50K |
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 | 627 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 628 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF OHIO | 554 | $106K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 627 | $32K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 505 | $14K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY, DBA ANTHEM BLUE CROSS AND BLUE SHIELD | 345 | $492K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 627 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.