| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 3900 E CAMELBACK ROAD SUITE 225 PHOENIX, AZ 85018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 5.32% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 3900 E CAMELBACK RD SUITE 225 PHOENIX, AZ 85018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $454 | $454 | 5.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $93K |
| MJ INSURANCE INC EIN 35-1109367 BROKER | Non-monetary compensation; Insurance brokerage commissions and fees; Other commissions; Insurance agents and brokers Service code 22 | — | $30K |
| ANTHEM INSURANCE COMPANIES INC EIN 35-0781558 BENEFIT ADMINISTRATOR | Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | — | $30K |
| ANTHEM INSURANCE COMPANIES, INC. | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | — | $4K |
| ANTHEM INSURANCE COMPANIES, INC EIN 35-0781558 OTHER - PHARMACY | Other fees Service code 99 | — | $3K |
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 | 238 | 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) | 238 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 116 | $35K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | UNIMERICA INSURANCE COMPANY | 103 | $504K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 116 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 116 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.