| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RUDY STAPLETON AND SON3 | 122 N MAIN STREET SWANTON, OH 43558 | AETNA LIFE INSURANCE CO. | $155K | — | $155K | 2.38% |
| STAPLETON GROUP, INC. | 122 N MAIN STREET SWANTON, OH 43558 | AETNA LIFE INSURANCE CO. | $35K | — | $35K | 0.53% |
| STAPLETON GROUP, INC.3 | P.O. BOX 1118 SYLVANIA, OH 43560 | PRINCIPAL LIFE INSURANCE COMPANY | $21K | $18K | $39K | 7.25% |
| STAPLETON GROUP, INC.3 Filed as: STAPLETON INSURANCE & RISK MANAGEME | P.O. BOX 1118 SYLVANIA, OH 43560 | PRINCIPAL LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| LAYNE FINANCIAL INC3 Filed as: LAYNE FINANCIAL, INC. | 315 GREEN RIDGE RD. STE. H1 NEW CASTLE, PA 161056145 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $28K | $6K | $34K | 13.07% |
| STAPLETON GROUP, INC.3 Filed as: STAPLETON INSURANCE & RISK MANAGEME | PO BOX 1118 SYLVANIA, OH 435605118 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $19K | $332 | $19K | 7.33% |
| LAYNE FINANCIAL INC3 Filed as: LAYNE FINANCIAL, INC. | 315 GREEN RIDGE RD. STE. H1 NEW CASTLE, PA 161056145 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $26K | $5K | $31K | 12.93% |
| STAPLETON GROUP, INC.3 Filed as: STAPLETON INSURANCE & RISK MANAGEME | P.O. BOX 1118 SYLVANIA, OH 435605118 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $17K | $250 | $18K | 7.30% |
| LAYNE FINANCIAL INC3 Filed as: LAYNE FINANCIAL, INC. | 315 GREEN RIDGE RD. STE. H1 NEW CASTLE, PA 161056145 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $2K | $11K | 12.93% |
| STAPLETON GROUP, INC.3 Filed as: STAPLETON INSURANCE & RISK MANAGEME | PO BOX 1118 SYLVANIA, OH 435605118 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $93 | $6K | 7.30% |
No Schedule C service providers reported on this filing.
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 | 991 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 991 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 1,426 | $6.5M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 1,640 | $533K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 1,640 | $533K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 1,640 | $774K |
| Short-term disability(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 1,640 | $794K |
| Long-term disability(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 1,640 | $622K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,640 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.