| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 8110 EAST 32ND STREET NORTH SUITE100 WICHITA, KS 67226 | BLUE CROSS AND BLUE SHIELD OF KANSAS | $2K | — | $2K | 3.52% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 8110 EAST 32ND STREET NORTH SUITE 100 WICHITA, KS 67226 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $297 | — | $297 | 12.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 8110 EAST 32ND STREET NORTH SUITE 100 WICHITA, KS 67226 | EYEMED | $54 | — | $54 | 20.93% |
| IMA, INC.3 | 1705 17TH STREET, SUITE 100 DENVER, CO 80202 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 17.65% |
| ASSUREX3 | 175 SOUTH THIRD STREET, SUITE 800 COLUMBUS, OH 43215 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $1 | $1 | 0.74% |
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 | 204 | 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) | 204 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF KANSAS | 155 | $53K |
| Dental | BLUE CROSS AND BLUE SHIELD OF KANSAS | 155 | $53K |
| Vision | EYEMED | 175 | $258 |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 204 | $2K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 204 | $2K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF KANSAS | 155 | $53K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 204 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 204 | — |
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.