| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ONI RISK PARTNERS INC3 | PO BOX 80159 INDIANAPOLIS, IN 46280 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 15.00% |
| ONI RISK PARTNERS INC3 | 600 E 96TH STREET STE 400 INDIANAPOLIS, IN 46240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| ONI RISK PARTNERS INC3 | 600 E 96TH STREET STE 400 INDIANAPOLIS, IN 46240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 INSURER | Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing Service code 12 | 220 VIRGINIA AVENUE INDIANAPOLIS, IN 46204 | $235K |
| ONI RISK PARTNERS INC | Other commissions; Non-monetary compensation; Insurance agents and brokers Service code 22 | — | $284 |
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 | 352 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 352 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | ANTHEM INSURANCE COMPANIES, INC. | 352 | $112K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 145 | $16K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 244 | $47K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 244 | $60K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. | 280 | $412K |
| Other(5 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 244 | $123K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 352 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.