| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $12K | $12K | 10.23% |
| ROSE STREET ADVISORS LLC3 | 244 N ROSE ST KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 1.14% |
| ROSE STREET ADVISORS LLC3 | 244 N ROSE ST KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | — | $14K | 20.00% |
| ROSE STREET ADVISORS LLC3 | 244 N ROSE ST KALAMAZOO, MI 49007 | VISION SERVICE PLAN | $5K | — | $5K | 10.00% |
| ROSE STREET ADVISORS LLC3 | 244 N ROSE ST KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 11.02% |
| ROSE STREET ADVISORS LLC3 | 244 N ROSE ST KALAMAZOO, MI 49007 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 23.89% |
| KIMBERLY JILL ZBIKOWSKI3 | 1786 DEEPWOOD DR SW WYOMING, MI 49519 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $717 | $3K | 15.06% |
| JEREMY SAMPSEL3 | 401 HALL ST SW, STE 225 GRAND RAPIDS, MI 49503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $1K | $2K | 13.90% |
| MELISSA DEVON WRIGHT-HALMON3 | 1109 POINT N JACKSON, MI 49201 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $166 | $1K | 8.14% |
| DIANNA LYNN ATCHISON3 | 225 E DIVISION ST ROCKFORD, MI 49341 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $487 | $414 | $901 | 5.15% |
| TIMOTHY JOEL WYNSMA3 | 7561 14TH AVE JENISON, MI 49428 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $587 | — | $587 | 3.36% |
| ROSE STREET ADVISORS LLC3 | 244 N ROSE ST KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| ROSE STREET ADVISORS LLC3 | 244 N ROSE ST KALAMAZOO, MI 49007 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $273 | — | $273 | 10.00% |
No Schedule C service providers reported on this filing.
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 | 325 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 325 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PRIORITY HEALTH INSURANCE COMPANY | 437 | $361K |
| Dental | DELTA DENTAL OF MICHIGAN | 491 | $147K |
| Vision | VISION SERVICE PLAN | 246 | $49K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 325 | $12K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 325 | $33K |
| Prescription drug | PRIORITY HEALTH INSURANCE COMPANY | 437 | $361K |
| Other(4 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 325 | $207K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 491 | — |
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.