| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FMLASOURCE INC5 | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $16K | $16K | 12.10% |
| TOTAL BENEFIT SOLUTIONS3 Filed as: TOTAL CONTROL HEALTH PLANS | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 4.27% |
| TOTAL BENEFIT SOLUTIONS3 Filed as: TOTAL CONTROL HEALTH PLANS | 148 S. RIVER AVE. SUITE 300 HOLLAND, MI 49423 | VISION SERVICE PLAN | $4K | — | $4K | 5.00% |
| TOTAL BENEFIT SOLUTIONS3 Filed as: TOTAL CONTROL HEALTH PLANS | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 6.58% |
| TOTAL BENEFIT SOLUTIONS3 Filed as: TOTAL CONTROL HEALTH PLANS | 148 S. RIVER AVE. SUITE 300 HOLLAND, MI 49423 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 6.85% |
| TOTAL BENEFIT SOLUTIONS3 Filed as: TOTAL CONTROL HEALTH PLANS | 148 S. RIVER AVE. SUITE 300 HOLLAND, MI 49423 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 5.00% |
| TOTAL BENEFIT SOLUTIONS5 Filed as: TOTAL CONTROL HEALTH PLANS | 148 S. RIVER AVE. SUITE 300 HOLLAND, MI 49423 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 2.80% |
| TOTAL BENEFIT SOLUTIONS3 Filed as: TOTAL CONTROL HEALTH PLANS | 148 S. RIVER AVE. SUITE 300 HOLLAND, MI 49423 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 10.00% |
| TOTAL BENEFIT SOLUTIONS5 Filed as: TOTAL CONTROL HEALTH PLANS | 148 S. RIVER AVE. SUITE 300 HOLLAND, MI 49423 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 4.02% |
| TOTAL BENEFIT SOLUTIONS3 Filed as: TOTAL CONTROL HEALTH PLANS | 148 S. RIVER AVE. SUITE 300 HOLLAND, MI 49423 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 13.16% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SISCO EIN 42-1144827 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | 800 MAIN ST. DUBUQUE, IA 52001 | $143K |
| TCHP, LLC EIN 82-4154183 AGENT | Insurance agents and brokers Service code 22 | 148 S. RIVER AVE. SUITE 300 HOLLAND, MI 49423 | $109K |
| FIRST HEALTH GROUP CORP EIN 20-1736437 PREFERRED PROVIDER NETWOR | Contract Administrator Service code 13 | 6720 ROCKLEDGE DR #700 BETHESDA, MD 20817 | $45K |
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 BENEFIT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | 4100 OKEMOS OKEMOS, MI 48864 | $21K |
| MEDICAL MUTUAL EIN 34-0648820 PREFERRED PROVIDER NETWOR | Contract Administrator Service code 13 | 100 AMERICAN ROAD CLEVELAND, OH 44144 | $8K |
| MIDLANDS CHOICE, INC. PREFERRED PROVIDER NETWOR | Contract Administrator Service code 13 | 13815 FNB PARKWAY, SUITE 250 OMAHA, NE 68154 | $2K |
| MULTIPLAN, INC. EIN 13-3068979 PREFERRED PROVIDER NETWOR | Contract Administrator Service code 13 | 115 5TH AVE NEW YORK, NY 10003 | $2K |
| THE HEALTHCARE GROUP, LLC EIN 35-2067373 PREFERRED PROVIDER NETWOR | Contract Administrator Service code 13 | 1776 N MERIDIAN ST STE 200 INDIANAPOLIS, IN 46202 | $2K |
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 | 998 | 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) | 998 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 554 | $76K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 998 | $130K |
| Short-term disability(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 262 | $226K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 138 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 998 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.