| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 500 WEST MONROE STREET, SUITE 3400 CHICAGO, IL 60661 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $9K | $9K | 2.96% |
| FMLA SOURCE INC5 | 455 NORTH CITYFRONT PLAZA DRIVE, 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $58K | $58K | 23.92% |
| LOCKTON COMPANIES, LLC3 | 500 WEST MONROE STREET, SUITE 3400 CHICAGO, IL 60661 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $7K | $7K | 3.09% |
| LOCKTON COMPANIES, LLC3 | 500 WEST MONROE STREET, SUITE 3400 CHICAGO, IL 60661 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 3.35% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $1.4M |
| CAPITAL RX EIN 35-2612946 ADMINISTRATOR | Contract Administrator Service code 13 | — | $207K |
| DELTA DENTAL OF KANSAS, INC EIN 48-0793267 ADMINISTRATOR | Contract Administrator Service code 13 | — | $121K |
| SURENCY LIFE & HEALTH INSURANCE EIN 26-1969006 ADMINISTRATOR | Contract Administrator Service code 13 | — | $45K |
| COMPSYCH EIN 36-3739783 ADMINISTRATOR | Contract Administrator Service code 13 | — | $45K |
| WEX HEALTH INC. EIN 06-1593514 ADMINISTRATOR | Contract Administrator Service code 13 | — | $13K |
| FMLA SOURCE INC ADMINISTRATOR | Contract Administrator Service code 13 | 455 N CITYFRONT PLAZA DR. CHICAGO, IL 60611 | $0 |
| UNITED OF OMAHA LIFE INSURANCE CO ADMINISTRATOR | Contract Administrator Service code 13 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | $0 |
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 | 2,530 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,541 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | SURENCY LIFE AND HEALTH | 2,373 | $251K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 2,530 | $312K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 2,530 | $296K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 2,530 | $312K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,530 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.