| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $1K | $7K | 12.37% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $851 | $851 | 1.58% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $2K | $11K | 33.40% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 6.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $756 | $756 | 2.20% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $1K | $7K | 23.77% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 6.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $541 | $541 | 1.88% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $778 | $778 | 5.02% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $389 | $389 | 2.51% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $583 | $3K | 19.45% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $525 | $525 | 4.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $291 | $291 | 2.22% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $450 | $3K | 24.07% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $663 | $663 | 6.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $225 | $225 | 2.04% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $500 | $2K | 14.95% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $250 | $250 | 2.48% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $222 | $1K | 17.87% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $309 | $309 | 3.99% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $111 | $111 | 1.44% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $677 | $219 | $896 | 19.86% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $271 | $271 | 6.01% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $110 | $110 | 2.44% |
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 | 203 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 203 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO | 182 | $1.1M |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 107 | $54K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 102 | $10K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 193 | $39K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 85 | $29K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 77 | $27K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 193 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 193 | — |
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.