| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | COMMUNITY INSURANCE COMPANY | $34K | $3K | $37K | 2.71% |
| USI INSURANCE SERVICES LLC3 | 1 HILLCREST DRIVE EAST CHARLESTON, WV 25311 | DELTA DENTAL OF OHIO | $3K | $304 | $3K | 4.80% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | $272 | $8K | 15.23% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $419 | $419 | 0.78% |
| ERIKA M PERRIN3 Filed as: ERIKA M. PERRIN | 11565 GRENADA CIRCLE NE HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $2K | $0 | $2K | 11.65% |
| DAVID CAMPANA INSURANCE LTD3 Filed as: DAVID CAMPANA INSURANCE LIMITED | 341 COPPER CREEK AMHERST, OH 44001 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $2K | $0 | $2K | 11.50% |
| USI INSURANCE SERVICES LLC3 | 312 ELM STREET, 24TH FLOOR CINCINNATI, OH 45202 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $734 | $0 | $734 | 3.59% |
| CGI VOLUNTARY BENEFITS, INC.3 | 3500 WOODRIDGE ROAD CLEVELAND HEIGHTS, OH 44121 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $350 | $0 | $350 | 1.71% |
| COVEY RUN INSURANCE LLC3 Filed as: COVEY RUN INS, LLC AND OTHER AGENTS | 6155 PARK SQUARE DRIVE, SUITE 7 LORAIN, OH 44053 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $228 | $33 | $261 | 1.28% |
| THOMAS W BOSTON3 Filed as: THOMAS W. BOSTON | 1275 WEST MAPLE STREET HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $133 | $0 | $133 | 0.65% |
| TIFFANY M. SEELING3 Filed as: TIFFANY M. SELLING | 6076 ARLYNE LANE MEDOMA, OH 44256 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $124 | $0 | $124 | 0.61% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $798 | $0 | $798 | 5.42% |
| USI INSURANCE SERVICES LLC3 | 1301 EAST 9TH STREET, SUITE 3800 CLEVELAND, OH 44114 | VISION SERVICE PLAN | $118 | $0 | $118 | 0.80% |
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 | 171 | 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) | 171 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY INSURANCE COMPANY | 284 | $1.4M |
| Dental | DELTA DENTAL OF OHIO | 276 | $65K |
| Vision | VISION SERVICE PLAN | 165 | $15K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 277 | $74K |
| Short-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 277 | $74K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 277 | $54K |
| Prescription drug | COMMUNITY INSURANCE COMPANY | 284 | $1.4M |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 277 | $74K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 284 | — |
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.