| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TERESA BURNETT3 | 1112 E JAMES ST DERBY, KS 67037 | AFLAC | $5K | $227 | $5K | 9.24% |
| LYNN E MOLLER3 | 332 E 1ST ST N WICHITA, KS 67202 | AFLAC | $1K | — | $1K | 2.18% |
| CALEB GILMOUR3 Filed as: CALEB J GILMOUR | 515 S MAIN ST STE 105 WICHITA, KS 67202 | AFLAC | $740 | $62 | $802 | 1.47% |
| BRANDON M UNREIN3 | 15275 SW INDIANOLA RD AUGUSTA, KS 67010 | AFLAC | $743 | $36 | $779 | 1.43% |
| ASHLE BURNETT3 | 1112 E JAMES ST DERBY, KS 67037 | AFLAC | $333 | $34 | $367 | 0.67% |
| MARC LUTHER HOMAN3 | 11828 W CENTRAL AVE STE 100 WICHITA, KS 67212 | AFLAC | $348 | — | $348 | 0.64% |
| JUSTIN C CARSON3 | 7701 E KELLOGG DR STE 680 WICHITA, KS 67207 | AFLAC | $238 | — | $238 | 0.44% |
| RUSTY J HELIN3 | 125 W 6TH ST COLBY, KS 67701 | AFLAC | $202 | $26 | $228 | 0.42% |
| PATRICIA ZOELLER3 | PO BOX 181 KINGMAN, KS 67068 | AFLAC | $115 | $50 | $165 | 0.30% |
| KATHY WIEDEMANN3 | 222 HIGH VIEW DR BOULDER, CO 80304 | AFLAC | $145 | — | $145 | 0.27% |
| WILLINGHAM INC3 | 1502 N METCALF RD LOUISBURG, KS 66053 | AFLAC | $129 | — | $129 | 0.24% |
| BRAD SCHUMACHER3 | 2804 COUNTRY LN HAYS, KS 67601 | AFLAC | $114 | — | $114 | 0.21% |
| BRIAN M LEITZEL3 | 7920 W KELLOGG DR STE 102 WICHITA, KS 67209 | AFLAC | $90 | — | $90 | 0.16% |
| REBECCA S MOLLER3 | PO BOX 463 ASHLAND, KS 67831 | AFLAC | $81 | — | $81 | 0.15% |
| JOHN C MAGNUSON3 | 507 S CORONADO AVE LINDSBORG, KS 67456 | AFLAC | $65 | — | $65 | 0.12% |
| MITCHELL K HANEY & ASSOC INC3 | 701 MCKINLEY ST GREAT BEND, KS 67530 | AFLAC | $64 | — | $64 | 0.12% |
| GARY WAYNE WILLINGHAM3 | 6033 STRAFFORD OAKS DR SEBRING, FL 33875 | AFLAC | $61 | — | $61 | 0.11% |
| DAN STECKLEIN3 | 2011 CENTRAL AVE LOWER LEVEL SOUTH DODGE CITY, KS 67801 | AFLAC | $56 | — | $56 | 0.10% |
| NATHAN L HARRISON3 | 16024 MANCHESTER RD 2ND FLOOR STE 200 ELLISVILLE, MO 63011 | AFLAC | $54 | — | $54 | 0.10% |
| GINGER D YOUNG3 | 8233 W MEADOW PASS WICHITA, KS 67205 | AFLAC | $49 | — | $49 | 0.09% |
| ALICE JAYLENE CHREST3 | 326 MARLA ST GREAT BEND, KS 67530 | AFLAC | $39 | $6 | $45 | 0.08% |
| GARY GIARRATANO3 | 13309 W 73RD ST SHAWNEE, KS 66216 | AFLAC | $43 | — | $43 | 0.08% |
| LEIGH ANNE SEEMAN3 | PO BOX 418 LARNED, KS 67550 | AFLAC | $23 | $6 | $29 | 0.05% |
| BRIAN M LEITZEL3 | 7920 W KELLOGG DR STE 103 WICHITA, KS 67209 | AFLAC | $28 | — | $28 | 0.05% |
| MADONNA L HASKINS3 Filed as: MADONNA HASKINS | PO BOX 1376 DODGE CITY, KS 67801 | AFLAC | $25 | — | $25 | 0.05% |
| KENNETH D MORRIS JR3 | 5410 PLYMOUTH DR LAWRENCE, KS 66049 | AFLAC | $22 | — | $22 | 0.04% |
| CALL INSURANCE SERV INC3 | PO BOX 1090 GREAT BEND, KS 67530 | AFLAC | $18 | — | $18 | 0.03% |
| DOUGLAS R SCHENKEL3 | 2205 WASHINGTON ST GREAT BEND, KS 67530 | AFLAC | $13 | — | $13 | 0.02% |
| IRA A CAPE3 | 2304 FRANKLIN ST GREAT BEND, KS 67530 | AFLAC | $11 | — | $11 | 0.02% |
| SHAWN D SCHWARZ3 | 1010 DOWNING AVE STE 20 HAYS, KS 67601 | AFLAC | $10 | — | $10 | 0.02% |
| JOHN A BACON3 | 11630 W 158TH TER OVERLAND PARK, KS 66221 | AFLAC | $9 | — | $9 | 0.02% |
| CHRISTOPHER THOMAS HIPP3 | 1601 MEADOW LN HAYS, KS 67601 | AFLAC | $8 | — | $8 | 0.01% |
| TERRY S DECKER3 | RR 2 BOX 22 TURPIN, OK 73950 | AFLAC | $7 | — | $7 | 0.01% |
| BRIAN MILLS3 | 1402 W LUCY WEBB RD RAYMORE, MO 64083 | AFLAC | $3 | — | $3 | 0.01% |
| SUE C TUCKER3 | 9856 US HIGHWAY 29 N CUSSETA, AL 36852 | AFLAC | $2 | — | $2 | 0.00% |
| JOHN A BACON3 | 13716 PARKHILL OVERLAND PARK, KS 66221 | AFLAC | $2 | — | $2 | 0.00% |
| INTERHAB5 | 1619 N WATERFRONT PKWY WICHITA, KS 67278 | DELTA DENTAL OF KANSAS, INC. | $2K | — | $2K | 3.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF KANSAS EIN 48-0952857 SERVICE PROVIDER | Contract Administrator Service code 13 | 1133 SW TOPEKA BLVD TOPEKA, KS 66629 | $86K |
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 | 171 | 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. |
| Total participants (= "Plan participants" tile) | 171 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF KANSAS | 156 | $429K |
| Dental | DELTA DENTAL OF KANSAS, INC. | 129 | $55K |
| Life insurance | ADVANCE INSURANCE COMPANY OF KANSAS | 171 | $14K |
| Long-term disability | AFLAC | 97 | $55K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF KANSAS | 156 | $375K |
| Other(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF KANSAS | 171 | $388K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 171 | — |
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."
No prospect flags tripped on this filing.