| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CENTERSTONE INSURANCE AND FINANCIAL3 | 12404 PARK CENTRAL DRIVE SUITE 400 DALLAS, TX 75251 | AETNA LIFE INSURANCE CO. | $13K | $0 | $13K | 2.56% |
| EDWARD D SOMMER3 Filed as: EDWARD D.A. SOMMER | 300 WEST WILSON BRIDGE ROAD SUITE 300 WORTHINGTON, OH 43085 | AETNA LIFE INSURANCE CO. | $3K | $0 | $3K | 0.49% |
| EDWARD D SOMMER3 | 300 WEST WILSON BRIDGE ROAD SUITE 300 WORTHINGTON, OH 43085 | STARMOUNT LIFE INSURANCE COMPANY | $4K | $0 | $4K | 10.00% |
| EDWARD D SOMMER3 | 300 WEST WILSON BRIDGE ROAD SUITE 300 WORTHINGTON, OH 43085 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 13.13% |
| CROWN INSURANCE INC3 Filed as: CROWN BENEFITS, LLC | PO BOX 2157 WESTERVILLE, OH 43086 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $68 | $0 | $68 | 0.45% |
| EDWARD D SOMMER3 Filed as: EDWARD DA SOMMER | 300 W. WILSON BRIDGE ROAD SUITE 300 WORTHINGTON, OH 43085 | VISION SERVICE PLAN | $785 | $0 | $785 | 7.14% |
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 | 140 | 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) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 169 | $524K |
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 123 | $40K |
| Vision | VISION SERVICE PLAN | 114 | $11K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 13 | $15K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 13 | $15K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 13 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 169 | — |
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.