| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WDCK, LLC3 Filed as: WDCK LLC | 5150 W JEFFERSON BLVD FORT WAYNE, IN 46804 | UNITED OF OMAHA LIFE INSURANCE COMPANY (1) | $3K | — | $3K | 15.00% |
| WDCK, LLC3 Filed as: WDCK LLC | 5150 W JEFFERSON BLVD FORT WAYNE, IN 46804 | UNITED OF OMAHA LIFE INSURANCE COMPANY (4) | $2K | — | $2K | 15.00% |
| WDCK, LLC3 Filed as: WDCK LLC | 5150 W JEFFERSON BLVD FORT WAYNE, IN 46804 | UNITED OF OMAHA LIFE INSURANCE COMPANY (3) | $900 | — | $900 | 14.99% |
| UNITED OF OMAHA LIFE INSURANCE CO5 Filed as: UNITED OF OMAHA LIFE INSURANCE | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY (2) | — | $3K | $3K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC EIN 35-0781558 TPA | Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Float revenue; Contract Administrator Service code 12 | 3350 PEACHTREE ROAD ATLANTA, GA 30326 | $86K |
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 | 118 | 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) | 118 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY (1) | 118 | $30K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY (1) | 118 | $30K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY (3) | 19 | $6K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC | 81 | $364K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY (2) | 118 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 118 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.