| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 1120 MADISON AVE. TOLEDO, OH 43604 | COMMUNITY INSURANCE COMPANY, DBA ANTHEM BLUE CROSS AND BLUE SHIELD | — | $515 | $515 | 0.09% |
| USI INSURANCE SERVICES LLC3 | 1120 MADISON AVE TOLEDO, OH 43604 | DELTA DENTAL OF OHIO | $2K | — | $2K | 1.44% |
| BROOKS INSURANCE AGENCY3 Filed as: BROOKS INSURANCE AGENCY, INC | 1120 MADISON AVE TOLEDO, OH 43604 | DELTA DENTAL OF OHIO | $803 | — | $803 | 0.65% |
| BROOK INSURANCE AGENCY INC3 | 1120 MADISON AVE. TOLEDO, OH 43604 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | — | $2K | 5.41% |
| USI INSURANCE SERVICES LLC3 | 1120 MADISON AVE TOLEDO, OH 43604 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $656 | — | $656 | 1.90% |
| USI INSURANCE SERVICES LLC3 | 1120 MADISON AVE TOLEDO, OH 43604 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 7.85% |
| BROOKS INSURANCE AGENCY3 Filed as: BROOKS INSURANCE AGENCY INC | 1120 MADISON AVE TOLEDO, OH 43604 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 6.14% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 NOT RELATED | Other services; Other fees; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator Service code 12 | 4361 IRWIN SIMPSON ROAD MASON, OH 45040 | $274K |
| USI INSURANCE SERVICES LLC | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $29K |
| BROOKS INSURANCE AGENCY | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $20K |
| SUN LIFE ASSURANCE COMPANY OF CANAD EIN 38-1082080 NOT RELATED | Claims processing Service code 12 | ONE SUN LIFE EXECUTIVE PARK WELLESLEY HILLS, MA 024815699 | $8K |
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 | 647 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 649 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF OHIO | 538 | $124K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 647 | $35K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 492 | $17K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY, DBA ANTHEM BLUE CROSS AND BLUE SHIELD | 347 | $555K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 492 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 647 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.