| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON | 1001 LAKESIDE AVENUE E, SUITE 1500 CLEVELAND, OH 44114 | UNITEDHEALTHCARE INSURANCE COMPANY | $30K | $0 | $30K | 2.49% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON | 93245 NETWORK PLACE CHICAGO, IL 60673 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $3K | $258 | $3K | 5.40% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON | 93245 NETWORK PLACE CHICAGO, IL 60673 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $664 | $9K | 16.18% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON | 93245 NETWORK PLACE CHICAGO, IL 60673 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $567 | $8K | 16.13% |
| DAVID CAMPANA INSURANCE LTD3 | 341 COPPER CREEK AMHERST, OH 44001 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.79% |
| CGI VOLUNTARY BENEFITS, INC.3 Filed as: CGI VOLUNTARY BENEFITS INC | 3500 WOODRIDGE ROAD CLEVELAND HEIGHTS, OH 44121 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $783 | $0 | $783 | 4.60% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS. SERVICES LLC | 312 ELM STREET, 24TH FLOOR CINCINNATI, OH 45202 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $343 | $0 | $343 | 2.01% |
| ELIZABETH J. TEPPER3 | 2223 NORTH JEFFERSON BOULEVARD LORAIN, OH 44052 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $160 | $0 | $160 | 0.94% |
| MJ INSURANCE3 Filed as: LAYNE FINANCIAL AND VARIOUS AGENTS | 3009 WILMINGTON ROAD, SUITE 100 NEW CASTLE, PA 16105 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $139 | $14 | $153 | 0.90% |
| COVEY RUN INSURANCE LLC3 | 341 COPPER CREEK AMHERST, OH 44001 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $106 | $0 | $106 | 0.62% |
| THOMAS W BOSTON3 Filed as: THOMAS W. BOSTON | 1275 WEST MAPLE STREET HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $90 | $0 | $90 | 0.53% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON | 93245 NETWORK PLACE CHICAGO, IL 60673 | EYEMED ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE COMPANY | $608 | $0 | $608 | 8.04% |
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 | 101 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 179 | $1.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 75 | $57K |
| Vision | EYEMED ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE COMPANY | 117 | $8K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 101 | $106K |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 101 | $106K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 179 | $1.2M |
| Other(4 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 102 | $127K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 179 | — |
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.