| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COX HEALTH SYSTEMS INSURANCE CO3 Filed as: COX HEALTH SYSTEMS INSURANCE COMPAN | PO BOX 5750 SPRINGFIELD, MO 65801 | COX HEALTH SYSTEMS INSURANCE COMPANY | — | $61K | $61K | 7.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | COX HEALTH SYSTEMS INSURANCE COMPANY | $4K | — | $4K | 0.44% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES-IL | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | DELTA DENTAL OF MISSOURI | — | $39 | $39 | 0.07% |
| PLANSOURCE BENEFIT ADMINISTRATION3 Filed as: PLANSOURCE BENE ADMINISTRATION INC | PO BOX 1313 ORLANDO, FL 32802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 13.36% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 300 SOUTH JEFFERSON AVENUE SUITE 600 SPRINGFIELD, MO 65806 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $697 | $697 | 4.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVENUE NORTHEAST SUITE 200 BELLEVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $261 | $261 | 1.68% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES-IL | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | ADVANTICA INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| PLANSOURCE BEN ADMINISTRATION INC5 | PO BOX 1313 ORLANDO, FL 32802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 15.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 300 SOUTH JEFFERSON AVENUE SUITE 600 SPRINGFIELD, MO 65806 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $339 | $339 | 4.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVENUE NORTHEAST SUITE 200 BELLEVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $127 | $127 | 1.64% |
| PLANSOURCE BEN ADMINISTRATION INC5 | PO BOX 1313 ORLANDO, FL 32803 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 70.99% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 300 SOUTH JEFFERSON AVENUE SUITE 600 SPRINGFIELD, MO 65806 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $169 | $169 | 3.80% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 777 108TH AVENUE NORTHEAST SUITE 200 BELLEVUE, WA 98004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $63 | $63 | 1.42% |
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 | 179 | 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) | 179 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COX HEALTH SYSTEMS INSURANCE COMPANY | 176 | $809K |
| Dental | DELTA DENTAL OF MISSOURI | 228 | $57K |
| Vision | ADVANTICA INSURANCE COMPANY | 167 | $12K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 192 | $20K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 36 | $8K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 192 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 228 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.