| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | PO BOX 844501 DALLAS, TX 75284 | DELTA DENTAL | $253 | $0 | $253 | 0.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 6100 S YALE AVE STE 1900 TULSA, OK 74132 | COLONIAL LIFE | $2K | $599 | $3K | 15.25% |
| WILLIAM D STAEDKE0 | 25695 E 71ST S BROKEN ARROW, OK 74014 | COLONIAL LIFE | $996 | $353 | $1K | 8.01% |
| MARILYN K EMBERSON0 | 7220 N HAMMOND AVE OKLAHOMA CITY, OK 73132 | COLONIAL LIFE | $829 | $64 | $893 | 5.30% |
| KELLY W PUGH0 | 7367 S 286TH E AVE BROKEN ARROW, OK 74014 | COLONIAL LIFE | $351 | $60 | $411 | 2.44% |
| SHANNON MARIE BALDWIN0 | 10222 E 114TH ST S BIXBY, OK 74008 | COLONIAL LIFE | $340 | $65 | $405 | 2.40% |
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 | 163 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMUNITY CARE | 163 | $484K |
| Dental | DELTA DENTAL | 8 | $54K |
| Life insurance | COLONIAL LIFE | 22 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 163 | — |
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.