| 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 | $2K | $6K | 13.45% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 2.30% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $2K | $11K | 35.84% |
| 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 | — | $1K | $1K | 3.42% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 27.87% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 6.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $882 | $882 | 3.93% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $969 | $969 | 5.52% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $484 | $484 | 2.76% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $795 | $2K | 22.22% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $441 | $441 | 4.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $397 | $397 | 3.60% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $954 | $612 | $2K | 16.41% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $306 | $306 | 3.21% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $493 | $2K | 20.55% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $356 | $356 | 4.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $246 | $246 | 2.77% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $683 | $2K | 32.10% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $342 | $342 | 6.06% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $339 | $339 | 6.01% |
| CHAMPION BENEFITS3 | 1455 LINCOLN PKWY E STE 100 ATLANTA, GA 30346 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $552 | $284 | $836 | 22.74% |
| AIA AMERICAN INS ADMINISTRATORS LLC5 | 4550 LENA DR MECHANICSBURG, PA 17055 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $221 | $221 | 6.01% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK STE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $142 | $142 | 3.86% |
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 | 122 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 122 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO | 127 | $1.0M |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 74 | $48K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 68 | $10K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $35K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 46 | $22K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 58 | $23K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 127 | — |
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.