| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HOLLIS AND BURNS INC3 | 700 COLONIAL RD. STE 250 MEMPHIS, TN 38117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE ADVANTAGE ADMINISTRATORS OF AR EIN 71-0226428 TPA | Contract Administrator Service code 13 | P. O. BOX 3743 LITTLE ROCK, AR 72203 | $107K |
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 | 205 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 205 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 205 | $68K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 205 | $68K |
| Stop-loss / reinsurancereinsurance | QBE INSURANCE | 186 | $259K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 205 | $68K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 205 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.