| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNITED OF OMAHA LIFE INSURANCE CO0 Filed as: UNITED OF OMAHA INSURANCE COMPANY | MUTUAL OF OMAHA PO BOX 2147 OMAHA, NE 68103 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | — |
| SMITH BOMAN & ASSOCIATES3 | 955 N STREET FRESNO, CA 93721 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | — |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES, LLC | 3475 E FOOTHILL BLVD STE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $378 | $0 | $378 | — |
| TAYLOR NOVIS3 | NOVIS INSURANCE SOLUTIONS 262 W CRESTVIEW DR PALM SPRINGS, CA 92264 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $195 | — | $195 | — |
| EKIZIAN & ASSOCIATES INSURANCE3 Filed as: EKIZIAN & ASSOCIATES, INC | 136 TREEHOUSE IRVINE, CA 92603 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $195 | — | $195 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NATIONAL UNDERWRITING SERVICES STOP LOSS CARRIER | Other fees Service code 99 | 1400 N PROVIDENCE RD BDG 2 STE 4050 MEDIA, PA 19063 | $155K |
| SMITH BOMAN & ASSOCIATES BROKER | Insurance agents and brokers Service code 22 | PO BOX 9817 FRESNO, CA 93794 | $35K |
| TRANSWESTERN INSURANCE ADMIN. EIN 77-0118024 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 45019 FRESNO, CA 93718 | $35K |
| BOLTON INSURANCE SERVICES, LLC BROKER | Insurance agents and brokers Service code 22 | 3475 E FOOTHILL BLVD STE 100 PASADENA, CA 91107 | $13K |
| EKIZIAN & ASSOCIATES, INC BROKER | Insurance agents and brokers Service code 22 | 136 TREEHOUSE IRVINE, CA 92603 | $7K |
| TAYLOR NOVIS BROKER | Insurance agents and brokers Service code 22 | NOVIS INSURANCE SOLUTIONS 262 W CRESTVIEW DR PALM SPRINGD, CA 92264 | $7K |
| HEALTHSMART PROVIDER CONTRACT | Other commissions Service code 55 | PO BOX 207102 DALLAS, TX 75320 | $3K |
| HINES & ASSOCIATES PROVIDER CONTRACT | Other commissions Service code 55 | PO BOX 0327 ELGIN, IL 60121 | $2K |
| MULTIPLAN, INC PROVIDER CONTRACT | Other commissions Service code 55 | PO BOX 29380 NEW YORK, NY 10087 | $1K |
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 | 119 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 119 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 0 | — |
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."
No prospect flags tripped on this filing.