| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 436045684 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | — | $9K | 12.73% |
| HYLANT GROUP INC3 | 8 CADILLAC DR STE 230 BRENTWOOD, TN 37027 | DELTA DENTAL OF INDIANA | $8K | — | $8K | 11.61% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43603 | VISION SERVICE PLAN | $958 | — | $958 | 6.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC EIN 35-0781558 NONE | Claims processing; Other services; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator Service code 12 | — | $118K |
| EXPRESS SCRIPTS, INC EIN 31-1714795 | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator Service code 12 | — | $0 |
| HYLANT GROUP INC EIN 34-1880366 | Insurance brokerage commissions and fees; Other commissions; Insurance agents and brokers Service code 22 | — | $0 |
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 | 265 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 265 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF INDIANA | 446 | $66K |
| Vision | VISION SERVICE PLAN | 188 | $16K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 265 | $67K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 265 | $67K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 265 | $67K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC | 238 | $217K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 265 | $67K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 446 | — |
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.