| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NUB RUNOFF INC3 | 4151 EXECUTIVE PKWY #340 WESTERVILLE, OH 43081 | COMMUNITY INSURANCE COMPANY (G1728) | $40K | $2K | $42K | 2.83% |
| SHAWAN MARQUIS AGENCY INC3 Filed as: SHAWAN MARQUIS AGENCY INC. | 110 EAST WILSON BRIDGE ROAD SUITE 260 COLUMBUS, OH 43085 | COMMUNITY INSURANCE COMPANY (G1728) | $514 | — | $514 | 0.03% |
| PBP RUNOFF INC3 | 4151 EXECUTIVE PKWY STE 340 WESTERVILLE, OH 43081 | COMMUNITY INSURANCE COMPANY (G1728) | -$43 | — | -$43 | -0.00% |
| VARIOUS - SEE ATTACHMENT3 | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19K | $3K | $23K | 31.35% |
| TRANSTAR INSURANCE BROKERS, INC.3 Filed as: TRANSTAR INSURANCE BROKERS | 5450 E. HIGH STREET, SUITE 300 PHOENIX, AZ 85054 | U.S. LEGAL SERVICES INC. | $1K | — | $1K | 9.70% |
| TRANSTAR INSURANCE BROKERS, INC.3 Filed as: TRANSTAR INSURANCE BROKERS INC. | 5450 E. HIGH STREET, SUITE 300 PHOENIX, AZ 85054 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 27.70% |
| INDIGO INSURANCE SERVICES3 | 101 HUNTINGTON AVENUE, SUITE 1300 BOSTON, MA 02199 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | — | $1K | $1K | 17.01% |
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 | 288 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 288 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY (G1728) | 407 | $1.5M |
| Dental | COMMUNITY INSURANCE COMPANY (G1728) | 407 | $1.5M |
| Vision | COMMUNITY INSURANCE COMPANY (G1728) | 407 | $1.5M |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 199 | $80K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 107 | $72K |
| Other(3 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 199 | $95K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 407 | — |
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.