Form 5500 · Employee benefit plan · NEW LEXINGTON, OH
LUDOWICI ROOF TILE, INC.
The filing calls this plan LUDOWICI ROOF TILE, INC. EMPLOYEE BENEFIT PLAN.
LUDOWICI ROOF TILE, INC. of NEW LEXINGTON, OH files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is ACISURE LLC. Coverage is written through SIRIUS AMERICA INSURANCE COMPANY and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 23-2563127 · plan 501 · plan year 2025, filed Jun 23, 2026
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How this plan is funded
Self-funded as reported
The filing reports a stop-loss contract and no medical premium, which is what a plan that pays its own claims reports.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
Also declared: other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 4 insured contracts covering health, life, disability and stop-loss; the largest, with SIRIUS AMERICA INSURANCE COMPANY, covers 165 people.
The filing declares health, life, disability, dental and vision. Dental and vision appear with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
The medical plan carries stop-loss coverage: the filing reports the plan paying its own health claims, with insured protection against large ones.
Reported premium across the insured contracts is $613,005, with $42,406 in disclosed broker commissions — about 6.9% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| AMERICAN UNITED LIFE INSURANCE COMPANY | Life, Disability | 167 | Jan 1, 2026 | $182,918 | $26,494 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | Health | 78 | Jan 1, 2026 | $40,827 | $8,783 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | Health | 30 | Jan 1, 2026 | $18,792 | $7,129 |
| SIRIUS AMERICA INSURANCE COMPANY | Stop-loss | 165 | Jan 1, 2026 | $370,468 | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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