| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TIC INC3 Filed as: TIC, INC | 701 SAND LAKE RD PO BOX 509 ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $4K | $6K | 11.86% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP, INC | 3 PARKWAY NORTH BLVD STE 500 PO BOX 509 DEERFIELD, IL 60015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $502 | $2K | 3.90% |
| TIC INC3 Filed as: TIC, INC | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $5K | 14.42% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP, INC | 3 PARKWAY NORTH BLVD STE 500 DEERFIELD, IL 60015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $315 | $3K | 8.50% |
| TIC INC3 Filed as: TIC, INC | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $1K | $3K | 16.03% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP, INC | 3 PARKWAY NORTH BLVD STE 500 DEERFIELD, IL 60015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $209 | $1K | 8.37% |
| TIC INC3 Filed as: TIC, INC | 701 SAND LAKE RD ONALASKA, WI 54650 | FIDELITY SECURITY LIFE | $1K | — | $1K | 10.05% |
| DIRECT BENEFITS3 Filed as: DIRECT BENEFITS INC | 55 E 5TH ST, SUITE 500 SAINT PAUL, MN 55101 | FIDELITY SECURITY LIFE | $817 | — | $817 | 6.03% |
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF MOAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | — |
| TIC INC3 Filed as: TIC, INC | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $201 | $201 | — |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP, INC | 3 PARKWAY NORTH BLVD STE 500 DEERFIELD, IL 60015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $29 | $29 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLEGIANCE BENEFIT PLAN MANAGEMENT, EIN 81-0400550 BENEFIT ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | 2806 GARFIELD ST MISSOULA, MT 59806 | $36K |
| DDM ASO, LLC EIN 41-1852523 BENEFIT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | NW 6112 PO BOX 1450 MINNEAPOLIS, MN 55485 | $7K |
| ALLEGIANCE CARE MANAGEMENT,INC EIN 03-0507057 BENEFIT ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | 2806 GARFIELD ST MISSOULA, MT 59806 | $5K |
| ALLEGIANCE COBRA SERVICES,INC EIN 71-0916514 BENEFIT ADMINISTRATOR | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator 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 | 102 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | FIDELITY SECURITY LIFE | 138 | $14K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $69K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $0 |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $32K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 105 | $828K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 138 | — |
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.