| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHAMPION BENEFITS3 | AN ALERA GROUP AGENCY LLC 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | AETNA LIFE INSURANCE CO | $480 | — | $480 | 0.05% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $104 | $6K | 10.19% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $118 | $118 | 0.22% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $123 | $10K | 29.35% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 6.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $106 | $106 | 0.30% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $67 | $4K | 20.38% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 6.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $58 | $58 | 0.33% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $45 | $45 | 0.29% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $39 | $39 | 0.26% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $39 | $1K | 10.39% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $33 | $33 | 0.33% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $27 | $1K | 15.35% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $312 | $312 | 4.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $23 | $23 | 0.30% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $25 | $1K | 20.35% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $416 | $416 | 6.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $22 | $22 | 0.32% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $626 | $15 | $641 | 15.36% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $250 | $250 | 5.99% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $13 | $13 | 0.31% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $457 | $11 | $468 | 15.37% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $122 | $122 | 4.01% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $9 | $9 | 0.30% |
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 | 113 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO | 216 | $1.0M |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 82 | $55K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 71 | $10K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $39K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 46 | $18K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 70 | $22K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 216 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.