| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HYLANT GROUP INC3 | 201 DEPOT ST STE 100 ANN ARBOR, MI 48104 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $39K | — | $39K | 10.63% |
| HYLANT GROUP INC3 | 811 MADISON AVE TOLEDO, OH 43604 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $17K | $17K | 4.62% |
| FMLASOURCE INC5 | 455 N CITYFRONT PLZ DR 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $8K | $8K | 2.28% |
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $6K | $6K | 1.62% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | 7440 WOODLAND DRIVE INDIANAPOLIS, IN 46278 | $330K |
| MAGELLAN RX MANAGEMENT, LLC EIN 46-3708039 PHARMACY BENEFIT MANAGER | Other fees; Direct payment from the plan; Claims processing Service code 12 | 2900 AMES CROSSING ROAD EAGAN, MI 55121 | $29K |
| DELTA DENTAL OF INDIANA EIN 35-1545647 BENEFIT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | 225 S EAST STREET INDIANAPOLIS, IN 46202 | $21K |
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 | 615 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 21 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 637 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 615 | $370K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 615 | $370K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 615 | $370K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 615 | $370K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 615 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.