| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLARKADAMSON, LLC3 | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $42K | $0 | $42K | 8.32% |
| ROGERS BENEFIT GROUP INC3 | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $26K | $26K | 5.09% |
| ADP INC3 Filed as: AUTOMATIC DATA PROCESSING INS AGCY | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $3K | $3K | 0.53% |
| BRADLEY JOHN BOS3 | 1809 W EVERGREEN ST DURANT, OK 74701 | AFLAC | $7K | $487 | $8K | 9.44% |
| KEVIN S. RIBERA3 Filed as: KEVIN S RIBERA | 2830 HAVEN BLVD APT 2202 DURANT, OK 74701 | AFLAC | $4K | $224 | $4K | 4.95% |
| SARAH CHLOUPEK3 | 1710 LARSPUR LN DURANT, OK 74701 | AFLAC | $3K | $8 | $3K | 3.41% |
| DAVID H. JOHNSON3 Filed as: DAVID H JOHNSON | 3377 BRYAN RD DURANT, OK 74701 | AFLAC | $1K | $0 | $1K | 1.49% |
| ALEX DEWALD3 | 1646 N 9TH AVE DURANT, OK 74701 | AFLAC | $645 | $326 | $971 | 1.19% |
| TIMOTHY W WORTHY JR3 Filed as: TIMOTHY B ALBRIGHT | 3525 ROCK BLUFF DR DURANT, OK 74701 | AFLAC | $908 | $0 | $908 | 1.11% |
| CHASTIN LYDAY-SMITH3 | 320 WESTERN HILLS DR DURANT, OK 74701 | AFLAC | $761 | $141 | $902 | 1.10% |
| CLARKADAMSON, LLC3 | 3603 FM 51 GAINESVILLE, TX 76240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $634 | $7K | 10.99% |
| GIS BENEFITS INC3 | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 2.65% |
| CLARKADAMSON, LLC3 | 3603 FM 51 GAINESVILLE, TX 76240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 10.00% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 5.00% |
| CLARKADAMSON, LLC3 | 3603 FM 51 GAINESVILLE, TX 76240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $571 | $5K | 16.97% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 7.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DR STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $761 | $761 | 2.62% |
| CLARKADAMSON, LLC3 | 3603 FM 51 GAINESVILLE, TX 76240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $547 | $5K | 16.97% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 7.62% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DR STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $729 | $729 | 2.62% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 7.56% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DR STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $369 | $369 | 2.56% |
| CLARKADAMSON, LLC3 | 3603 FM 51 GAINESVILLE, TX 76240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $277 | $277 | 1.92% |
| CLARKADAMSON, LLC3 | 3603 FM 51 GAINESVILLE, TX 76240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 15.00% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $671 | $671 | 5.00% |
| CLARKADAMSON, LLC3 | 3603 FM 51 GAINESVILLE, TX 76240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 15.00% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $608 | $608 | 5.00% |
| CLARKADAMSON, LLC3 | — | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $231 | $1K | 12.01% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $574 | $574 | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DR STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $308 | $308 | 2.68% |
| CLARKADAMSON, LLC3 | 3603 FM 51 GAINESVILLE, TX 76240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $144 | $1K | 17.07% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS | 422 WAUPONSEE ST MORRIS, IL 60450 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $388 | $388 | 5.56% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DR STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $193 | $193 | 2.76% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $338 | $338 | 4.99% |
| CLARKADAMSON, LLC3 | 3603 FM 51 GAINESVILLE, TX 76240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $527 | $0 | $527 | 9.99% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $264 | $264 | 5.01% |
| CLARKADAMSON, LLC3 | 3603 FM 51 GAINESVILLE, TX 76240 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $500 | $0 | $500 | 15.01% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE SERVICES | 1607 N AURORA RD STE 201 NAPERVILLE, IL 60563 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $167 | $167 | 5.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 ADMINISTRATOR | Direct payment from the plan; Claims processing; Participant communication; Named fiduciary; Contract Administrator Service code 12 | — | $14K |
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 | 178 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 182 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 162 | $505K |
| Dental(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 127 | $93K |
| Vision(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 128 | $17K |
| Life insurance(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 180 | $53K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 72 | $40K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 57 | $21K |
| Other(5 contracts, 2 carriers) | AFLAC | 180 | $134K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.