| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FMLASOURCE INC5 Filed as: FMLASOURCE, INC. | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $159K | $159K | 6.56% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $89K | $63K | $153K | 6.30% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY AND ASSOC. INS. GROUP, INC. | 1 KELLY WAY SPARKS GLENCO, MD 21152 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $91K | $44K | $135K | 5.57% |
| OPTA VISE, LLC5 | 11825 NORTH PENN STREET CARMEL, IN 46032 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $92K | $92K | 3.80% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY AND ASSOC. INS. GROUP, INC. | 1 KELLY WAY SPARKS, MD 21152 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 0.14% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $53K | $51K | $104K | 6.40% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY AND ASSOC. INS. GROUP, INC. | 1 KELLY WAY SPARKS GLENCO, MD 21152 | STANDARD INSURANCE COMPANY | $53K | $0 | $53K | 3.29% |
| DIRECTPATH, LLC3 Filed as: DIRECT PATH, LLC | UNKNOWN LOUISVILLE, KY 40299 | COMBINED INSURANCE COMPANY OF AMERICA | $135K | $0 | $135K | 10.21% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY AND ASSOC. INS. GROUP, INC. | 1 KELLY WAY SPARKS, MD 21152 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $16K | $0 | $16K | 4.99% |
| USI INSURANCE SERVICES LLC3 | 7770 JEFFERSON, SUITE 101 ALBUQUERQUE, NM 87109 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $16K | $0 | $16K | 4.99% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | 9811 KATY FREEWAY, SUITE 500 HOUSTON, TX 77024 | PAN-AMERICAN LIFE INSURANCE COMPANY | $5K | $0 | $5K | 6.00% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY AND ASSOC. INS. GROUP, INC. | 1 KELLY WAY SPARKS GLENCO, MD 21152 | PAN-AMERICAN LIFE INSURANCE COMPANY | $5K | $0 | $5K | 6.00% |
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 | 5,058 | 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) | 5,058 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PAN-AMERICAN LIFE INSURANCE COMPANY | 115 | $90K |
| Dental | STANDARD INSURANCE COMPANY | 2,536 | $1.6M |
| Vision(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 4,046 | $1.9M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 5,058 | $2.4M |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 5,058 | $2.4M |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 5,058 | $2.4M |
| Prescription drug | CAPITAL RX, INC. | 5,058 | $397K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 5,882 | $3.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,882 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.