| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FORUM BENEFITS INC3 Filed as: FORUM BENEFITS, INC. | 1122 S MAIN ST STE B GREENVILLE, SC 29601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $701 | $5K | 11.77% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $801 | $801 | 2.02% |
| FORUM BENEFITS INC3 Filed as: FORUM BENEFITS, INC. | 1122 S MAIN ST STE B GREENVILLE, SC 29601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $1K | $6K | 18.41% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 2.92% |
| FORUM BENEFITS INC3 Filed as: FORUM BENEFITS, INC. | 1122 S MAIN ST STE B GREENVILLE, SC 29601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $947 | $5K | 18.66% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $812 | $812 | 3.14% |
| FORUM BENEFITS INC3 Filed as: FORUM BENEFITS, INC. | 1122 S MAIN ST STE B GREENVILLE, SC 29601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $894 | $5K | 18.64% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $766 | $766 | 3.12% |
| FORUM BENEFITS INC3 Filed as: FORUM BENEFITS, INC. | 1122 S MAIN ST STE B GREENVILLE, SC 29601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $399 | $2K | 18.65% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $342 | $342 | 3.13% |
| FORUM BENEFITS INC3 Filed as: FORUM BENEFITS, INC. | 1122 S MAIN ST STE B GREENVILLE, SC 29601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $248 | $2K | 17.67% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $213 | $213 | 2.30% |
| FORUM BENEFITS INC3 Filed as: FORUM BENEFITS, INC. | 1122 S MAIN ST STE B GREENVILLE, SC 29601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $689 | $252 | $941 | 13.66% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $216 | $216 | 3.13% |
| FORUM BENEFITS INC3 Filed as: FORUM BENEFITS, INC. | 1122 S MAIN ST STE B GREENVILLE, SC 29601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $880 | $95 | $975 | 22.16% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $81 | $81 | 1.84% |
| FORUM BENEFITS INC3 Filed as: FORUM BENEFITS, INC. | 1122 S MAIN ST STE B GREENVILLE, SC 29601 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $362 | $40 | $402 | 16.64% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $35 | $35 | 1.45% |
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 | 109 | 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) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 82 | $40K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 74 | $7K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 111 | $11K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 85 | $35K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 111 | $25K |
| Other(7 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 111 | $127K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 111 | — |
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.