| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JACQUELINE K QUALIZZA3 | 12877 W 151ST STREET OLATHE, KS 66062 | BLUECROSS BLUESHIELD OF OKLAHOMA | $44K | $880 | $45K | 5.10% |
| CERESTA L HILL3 | 5216 NW 111TH STREET OKLAHOMA CITY, OK 73162 | AFLAC | $3K | $99 | $4K | 5.31% |
| JUDY C ELWOOD3 | 810526 S HIGHWAY 177 CARNEY, OK 74832 | AFLAC | $3K | — | $3K | 4.93% |
| DONNA CDEBACA STEWART3 | 3501 FRENCH PARK DR STE E EDMOND, OH 73034 | AFLAC | $2K | $20 | $2K | 3.09% |
| BOBBY R STEWART3 | 3501 FRENCH PARK DRIVE SUITE E EDMOND, OK 73034 | AFLAC | $1K | $29 | $1K | 1.93% |
| CATRINA D DELLINGER3 | 617 E GREENWOOD LANE MUSTANG, OK 73064 | AFLAC | $305 | — | $305 | 0.46% |
| REGAN WAGNER3 | 1004 EARL A RODKEY DR EDMOND, OK 73003 | AFLAC | $122 | $47 | $169 | 0.25% |
| CAROLYN BENDER3 | 917 EGGLESTON STREET FORT COLLINS, OK 80524 | AFLAC | $152 | — | $152 | 0.23% |
| CHARLES D MANGUS3 | 1305 PULCHELLA WAY NEWCASTLE, OK 73065 | AFLAC | $121 | — | $121 | 0.18% |
| LARRY D DENNY3 | PO BOX 306 WETUMKA, OK 74883 | AFLAC | $112 | — | $112 | 0.17% |
| TREY CDEBACA3 | 1004 EARL A RODKEY DR EDMOND, OK 73003 | AFLAC | $89 | $9 | $98 | 0.15% |
| STEPHEN W SIMPSON3 | 540 CELTIC CT EDMOND, OK 73025 | AFLAC | $97 | — | $97 | 0.15% |
| KEVIN KHOURY3 | 918 NW 17TH ST OKLAHOMA CITY, OK 73106 | AFLAC | $69 | — | $69 | 0.10% |
| LISA B NEWPORT3 | 1009 SETTLERS DR EDMOND, OK 73034 | AFLAC | $69 | — | $69 | 0.10% |
| LESTER RAY BLACKSHEAR3 | 9192 SE 168TH COOK PL THE VILLAGES, FL 32162 | AFLAC | $60 | — | $60 | 0.09% |
| JAMES MICHAEL WILLIAMS3 | 235 CHELSEA WAY SULPHUR, OK 73086 | AFLAC | $50 | — | $50 | 0.08% |
| JOHN A WILLIAMS COMPANY INC3 | 20316 N COUNTY ROAD 3240 PAULS VALLEY, OK 73075 | AFLAC | $40 | — | $40 | 0.06% |
| COOPER SCOTT YEATES3 | 2133 E 2ND ST APT 4208 EDMOND, OK 73034 | AFLAC | $35 | — | $35 | 0.05% |
| MOFFAT DESIGNS LLC3 | 1221 LAMPLIGHTER LN EDMOND, OK 73034 | AFLAC | $21 | — | $21 | 0.03% |
| JARRELL K PRENTICE3 | 1113 EAST DR EDMOND, OK 73034 | AFLAC | $13 | — | $13 | 0.02% |
| JOSHUA C ROLAN3 | 704 SEMINOLE DR PAULS VALLEY, OK 73075 | AFLAC | $12 | — | $12 | 0.02% |
| PAUL B BROUCHOUD3 | 604 MARK DR DEL CITY, OK 73115 | AFLAC | $11 | — | $11 | 0.02% |
| SHANE M OWEN3 | 8413 NW 106TH ST OKLAHOMA CITY, OK 73162 | AFLAC | $10 | — | $10 | 0.02% |
| SHARON J FITZPATRICK3 | 4516 KINDLING AVE GUTHRIE, OK 73044 | AFLAC | $9 | — | $9 | 0.01% |
| EDWARD A HALL JR3 | 2224 WOODMARSH CIR AUBURN, GA 30011 | AFLAC | $2 | — | $2 | 0.00% |
| JAMES D DUDLEY3 | 1355 LYNNFIELD ST STE 259 MEMPHIS, TN 38119 | AFLAC | $1 | — | $1 | 0.00% |
| JACQUELINE K QUALIZZA3 | ASSOCIATION INSURANCE SERVICES 12877 W 151TH STREET OLATHE, KS 66062 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $4K | — | $4K | 14.95% |
| JUDY C ELWOOD3 Filed as: JUDY CHRISTINE ELWOOD | 810526 S HIGHWAY 177 CARNEY, OK 748324845 | AMERITAS LIFE INSURANCE CORP. | $580 | — | $580 | 10.01% |
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 | 120 | 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) | 120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF OKLAHOMA | 135 | $890K |
| Dental | AFLAC | 66 | $67K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 68 | $6K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 122 | $91K |
| Short-term disability | AFLAC | 66 | $67K |
| Other(2 contracts, 2 carriers) | AFLAC | 122 | $91K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.