| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURANCE SPECIALISTS LLC3 | 1750 SCOTTSVILLE ROAD, SUITE 4 BOWLING GREEN, KY 42104 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $74K | $26K | $100K | 20.21% |
| INSURANCE SPECIALISTS LLC3 Filed as: INSURANCE SPECIALISTS | 1750 SCOTTSVILLE ROAD, SUITE 4 BOWLING GREEN, KY 42104 | VISION SERVICE PLAN | $3K | — | $3K | 2.32% |
| INSURANCE SPECIALISTS LLC3 | 1750 SCOTTSVILLE ROAD, SUITE 4 BOWLING GREEN, KY 42104 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $12K | $225 | $12K | 21.20% |
| TED BENNETT3 | 1830 DESTINY LANE BOWLING GREEN, KY 42104 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $802 | $500 | $1K | 2.26% |
| MJ INSURANCE3 Filed as: DAVID E. WYATT AND VARIOUS AGENTS | 1011 NORTH 49TH AVENUE OMAHA, NE 68132 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $535 | $134 | $669 | 1.16% |
| CLARICE R MIMS3 Filed as: CLARICE R. MIMS | 172-90 HIGHLAND AVENUE JAMAICA ESTATES, NY 11432 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $179 | $39 | $218 | 0.38% |
| EDGHILL ENTERPRISES LLC3 | 2116 WEST KOEING GRAND ISLAND, NE 68803 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $96 | $17 | $113 | 0.20% |
| JACQUELINE BARTHELEMY3 Filed as: JACQUELINE MARIE STUEMKY | 10208 MIDDLE DARLEEN LEANDER, TX 78641 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $89 | $13 | $102 | 0.18% |
| CHALSEE CANTRELL3 | 1007 THISTLE DRIVE MESQUITE, TX 75149 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $69 | $16 | $85 | 0.15% |
| RONALD CHAMBERS4 Filed as: RONALD H. CHAMBERS | 3281 PLATEAU PLACE CINCINNATI, OH 45241 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $1K | — | $1K | 12.37% |
| JOSEPH A. VALENTIC4 | 37679 JEROME DRIVE STERLING HEIGHTS, MI 48312 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $175 | — | $175 | 1.97% |
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 | 899 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 907 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 515 | $130K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 961 | $495K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 961 | $495K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 961 | $495K |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 961 | $561K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 961 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.