| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 1120 MADISON AVE. TOLEDO, OH 43604 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | — | $2K | 5.77% |
| USI INSURANCE SERVICES LLC3 | 1120 MADISON AVE TOLEDO, OH 43604 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 24.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 NOT RELATED | Claims processing; Insurance brokerage commissions and fees; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator; Other commissions; Insurance agents and brokers; Other fees Service code 12 | 4361 IRWIN SIMPSON ROAD MASON, OH 45040 | $293K |
| 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 | $13K |
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 | 633 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 635 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF OHIO | 497 | $100K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 633 | $32K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 473 | $14K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY, DBA ANTHEM BLUE CROSS AND BLUE SHIELD | 457 | $574K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 473 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 633 | — |
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.