| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 1001 LAKESIDE AVENUE EAST SUITE 1500 CLEVELAND, OH 44114 | UNITEDHEALTHCARE INSURANCE COMPANY | $26K | $0 | $26K | 1.79% |
| HYLANT GROUP INC3 Filed as: HYLANT GROUP, INC. | 811 MADISON AVENUE TOLEDO, OH 43604 | UNITEDHEALTHCARE INSURANCE COMPANY | $12K | $0 | $12K | 0.85% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 6300 BRIDGPOINT PARKWAY BUILDING 3, SUITE 500 AUSTIN, TX 78730 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $8K | $0 | $8K | 9.77% |
| HYLANT GROUP INC3 Filed as: HYLANT GROUP, INC. | 811 MADISON AVENUE TOLEDO, OH 43604 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | $0 | $6K | 7.22% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $23 | $23 | 0.03% |
| DAVID CAMPANA INSURANCE LTD3 | 6145 PARK SQUARE DRIVE, SUITE 5 LORAIN, OH 44053 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3K | $0 | $3K | 14.75% |
| CGI VOLUNTARY BENEFITS, INC.3 | 20046 WALKER ROAD, SUITE 5 SHAKER HEIGHTS, OH 44121 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $466 | $0 | $466 | 2.16% |
| USI INSURANCE SERVICES LLC3 | 312 ELM STREET, 24TH FLOOR CINCINNATI, OH 45202 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $270 | $0 | $270 | 1.25% |
| BOSTON THOMAS W3 Filed as: BOSTON THOMAS W & OTHER AGENTS | 139 MARKET AVENUE NE HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $189 | $0 | $189 | 0.88% |
| LAYNE FINANCIAL INC3 Filed as: LAYNE FINANCIAL, INC. | 3009 WILMINGTON ROAD, SUITE 100 NEW CASTLE, PA 16105 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $127 | $0 | $127 | 0.59% |
| COVEY RUN INSURANCE LLC3 Filed as: COVEY RUN INSURANCE, LLC | 341 COPPER CREEK AMHERST, OH 44001 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $90 | $0 | $90 | 0.42% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON US, LLC | PO BOX 28852 NEW YORK, NY 10087 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $0 | $13 | $13 | 0.06% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 93245 NETWORK PLACE CHICAGO, IL 60673 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $518 | $0 | $518 | 15.01% |
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 | 107 | 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) | 107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 204 | $1.4M |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 204 | $1.4M |
| Vision | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | 156 | $9K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 107 | $82K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 107 | $82K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 107 | $82K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 204 | $1.4M |
| Other(5 contracts, 5 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 204 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 204 | — |
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.