| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TIC INC3 Filed as: TIC, INC | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $3K | $7K | 13.88% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 2.95% |
| TIC INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $7K | 20.88% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $926 | $926 | 2.94% |
| TIC INC3 Filed as: TIC, INC | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 20.57% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $581 | $581 | 2.78% |
| TIC INC3 Filed as: TIC, INC | 701 SAND LAKE RD ONALASKA, WI 54650 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| DIRECT BENEFITS INC3 | 55 E 5TH ST, SUITE 500 SAINT PAUL, MN 55101 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $910 | — | $910 | 6.00% |
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF MOAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | — |
| TIC INC3 Filed as: TIC, INC | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $174 | $174 | — |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $87 | $87 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLEGIANCE BENEFIT PLAN MANAGEMENT, EIN 81-0400550 BENEFIT ADMINISTRATOR | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 2806 GARFIELD ST MISSOULA, MT 59806 | $34K |
| DDM ASO, LLC EIN 41-1852523 BENEFIT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | NW 6112 PO BOX 1450 MINNEAPOLIS, MN 55485 | $7K |
| ALLEGIANCE CARE MANAGEMENT,INC EIN 03-0507057 BENEFIT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | 2806 GARFIELD ST MISSOULA, MT 59806 | $5K |
| ALLEGIANCE COBRA SERVICES,INC EIN 71-0916514 BENEFIT ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | 2806 GARFIELD ST MISSOULA, MT 59806 | $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 | 105 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 150 | $15K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 119 | $71K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 118 | $0 |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 118 | $31K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 106 | $648K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 150 | — |
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."
No prospect flags tripped on this filing.