| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 245 N WACO ST, STE 300 WICHITA, KS 67202 | TRANSAMERICA LIFE | $16K | — | $16K | 10.00% |
| CAPROCK HEALTHPLANS3 | 4401 82ND ST, SUITE 1200 LUBBOCK, TX 79424 | TRANSAMERICA LIFE | $8K | — | $8K | 5.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST LLC | 245 N. WACO ST SUITE 300 WICHITA, KS 67202 | UNION SECURITY INSURANCE COMPANY | $8K | $4K | $11K | 20.41% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES INC | 245 N. WACO ST SUITE 300 WICHITA, KS 67202 | UNION SECURITY INSURANCE COMPANY | $2K | — | $2K | 3.27% |
| USI INSURANCE SERVICES LLC3 Filed as: USI MIDWEST, LLC | 245 N WACO SUITE 300 WICHITA, KS 67202 | DELTA DENTAL OF KANSAS, INC. | $442 | — | $442 | 1.25% |
| CAPROCK HEALTHPLANS3 | 4401 82ND STREET, SUITE 1200 LUBBOCK, TX 79424 | OPTUM | $852 | — | $852 | 10.00% |
| GAIL COE3 | 4600 FARMSTEAD CT WICHITA, KS 67220 | AFLAC | $548 | — | $548 | 10.80% |
| USI INSURANCE SERVICES LLC3 | P O BOX 206 WICHITA, KS 67201 | AFLAC | $129 | — | $129 | 2.54% |
| JUSTIN C CARSON3 Filed as: JUSTIN CARSON | 7701 E KELLOGG DRIVE SUITE 680 WICHITA, KS 67207 | AFLAC | $95 | — | $95 | 1.87% |
| VARIOUS3 | — | AFLAC | $63 | — | $63 | 1.24% |
| KATHY WIEDEMANN3 | 220 HIGH VIEW DRIVE BOULDER, CO 80304 | AFLAC | $55 | — | $55 | 1.08% |
| SAMUEL A MCFALL3 Filed as: SAMUEL MCFALL | 609 N BROADWAY SUITE 200 WICHITA, KS 67214 | AFLAC | $36 | — | $36 | 0.71% |
| HOLLY A. TIMMERMEYER3 Filed as: HOLLY TIMMERMEYER | 201 E 12TH STREET HAYS, KS 67601 | AFLAC | $26 | — | $26 | 0.51% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| USI EIN 13-3771734 BROKER | Insurance agents and brokers Service code 22 | 245 N WACO ST SUITE 30C WICHITA, KS 672021116 | $38K |
| CAPROCK HEALTHPLANS EIN 26-1569907 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | 4401 82ND STREET STE 1200 LUBBOCK, TX 79424 | $33K |
| PROVI DRS CHOICE EIN 48-0959093 PPO | Claims processing Service code 12 | 1102 S HILLSIDE WICHITA, KS 67211 | $5K |
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 | 120 | 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) | 120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF KANSAS, INC. | 63 | $35K |
| Life insurance | UNION SECURITY INSURANCE COMPANY | 120 | $56K |
| Short-term disability(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 120 | $61K |
| Stop-loss / reinsurancereinsurance | TRANSAMERICA LIFE | 88 | $156K |
| Other(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 120 | $64K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 120 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.