| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 1 SEAGATE SUITE 1850 TOLEDO, OH 43604 | COMMUNITY INSURANCE COMPANY, DBA ANTHEM BLUE CROSS AND BLUE SHIELD | — | $2K | $2K | 0.25% |
| USI INSURANCE SERVICES LLC3 | 1 SEAGATE SUITE 1850 TOLEDO, OH 43604 | DELTA DENTAL OF OHIO | $2K | — | $2K | 1.96% |
| USI INSURANCE SERVICES LLC3 | 1 SEAGATE SUITE1850 TOLEDO, OH 43604 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | — | $2K | 6.13% |
| USI INSURANCE SERVICES LLC3 | 1 SEAGATE SUITE 1850 TOLEDO, OH 43604 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 20.89% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 NOT RELATED | Other commissions; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Claims processing; Insurance brokerage commissions and fees; Other fees; Insurance agents and brokers Service code 12 | 4361 IRWIN SIMPSON ROAD MASON, OH 45040 | $297K |
| 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 | $14K |
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 | 711 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 717 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF OHIO | 478 | $109K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 597 | $32K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 711 | $12K |
| Stop-loss / reinsurancereinsurance | COMMUNITY INSURANCE COMPANY, DBA ANTHEM BLUE CROSS AND BLUE SHIELD | 462 | $616K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 711 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 711 | — |
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.