| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JACQUELINE K QUALIZZA3 | 12877 W 151ST STREET OLATHE, KS 66062 | UNITEDHEALTHCARE INSURANCE COMPANY | $3K | $27K | $30K | 4.26% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP INC - KS & MO | 475 MARTINGALE RD SCHAUMBURG, IA 60173 | UNITEDHEALTHCARE INSURANCE COMPANY | $9K | — | $9K | 1.21% |
| CERESTA L HILL3 | 5216 NW 111TH STREET OKLAHOMA CITY, OK 73162 | AFLAC | $3K | $208 | $3K | 5.59% |
| JUDY C ELWOOD3 | 810526 S HIGHWAY 177 CARNEY, OK 74832 | AFLAC | $2K | — | $2K | 4.23% |
| DONNA CDEBACA STEWART3 Filed as: DONNA STEWART | 3501 FRENCH PARK DR STE E EDMOND, OH 73034 | AFLAC | $2K | $57 | $2K | 3.36% |
| BRIAN K EVERETT3 | 2160 SANDPIPER DR BLANCHARD, OK 73010 | AFLAC | $513 | $57 | $570 | 1.02% |
| BOBBY R STEWART3 | 3501 FRENCH PARK DRIVE SUITE E EDMOND, OK 73034 | AFLAC | $551 | — | $551 | 0.98% |
| CATRINA D DELLINGER3 | 617 E GREENWOOD LANE MUSTANG, OK 73064 | AFLAC | $194 | — | $194 | 0.35% |
| CAROLYN BENDER3 | 917 EGGLESTON STREET FORT COLLINS, CO 80524 | AFLAC | $99 | — | $99 | 0.18% |
| CHARLES D MANGUS3 | 1305 PULCHELLA WAY NEWCASTLE, OK 73065 | AFLAC | $76 | — | $76 | 0.14% |
| LARRY D DENNY3 | PO BOX 306 WETUMKA, OK 74883 | AFLAC | $71 | — | $71 | 0.13% |
| STACY HAMPTON3 | 2409 N KELLER DR STILLWATER, OK 74075 | AFLAC | $34 | $36 | $70 | 0.13% |
| STEPHEN W SIMPSON3 | 540 CELTIC CT EDMOND, OK 73025 | AFLAC | $51 | — | $51 | 0.09% |
| KEVIN KHOURY3 | 920 NW 17TH ST OKLAHOMA CITY, OK 73106 | AFLAC | $41 | — | $41 | 0.07% |
| LESTER RAY BLACKSHEAR3 | 9192 SE 168TH COOK PL THE VILLAGES, FL 32162 | AFLAC | $37 | — | $37 | 0.07% |
| LISA B NEWPORT3 | 1009 SETTLERS DR EDMOND, OK 73034 | AFLAC | $35 | — | $35 | 0.06% |
| TREY CDEBACA3 | 1004 EARL A RODKEY DR EDMOND, OK 73003 | AFLAC | $32 | — | $32 | 0.06% |
| JOHN A WILLIAMS COMPANY INC3 | 20316 N COUNTY ROAD 3240 PAULS VALLEY, OK 73075 | AFLAC | $26 | — | $26 | 0.05% |
| REGAN WAGNER3 Filed as: REGAN DANIELLE CDEBACA | 1004 EARL A RODKEY DR EDMOND, OK 73003 | AFLAC | $19 | — | $19 | 0.03% |
| COOPER SCOTT YEATES3 | 2133 2ND ST APT 4208 EDMOND, OK 73034 | AFLAC | $15 | — | $15 | 0.03% |
| HAL W MOFFATT3 Filed as: HAL MOFFATT | 1221 LAMPLIGHTER LN EDMOND, OK 73034 | AFLAC | $13 | — | $13 | 0.02% |
| JARRELL K PRENTICE3 | 1113 EAST DR EDMOND, OK 73034 | AFLAC | $7 | — | $7 | 0.01% |
| JOSHUA C ROLAN3 | 704 SEMINOLE DR PAULS VALLEY, OK 73075 | AFLAC | $7 | — | $7 | 0.01% |
| PAUL B BROUCHOUD3 | 604 MARK DR DEL CITY, OK 73115 | AFLAC | $7 | — | $7 | 0.01% |
| SHANE M OWEN3 | 8413 NW 106TH ST OKLAHOMA CITY, OK 73162 | AFLAC | $6 | — | $6 | 0.01% |
| EDWARD A HALL JR3 Filed as: EDWARD HALL JR | 2224 WOODMARSH CIR AUBURN, GA 30011 | AFLAC | $2 | — | $2 | 0.00% |
| JACQUELINE K QUALIZZA3 | ASSOCIATION INSURANCE SERVICES 12877 W 151TH STREET OLATHE, KS 66062 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| JUDY C ELWOOD3 Filed as: JUDY CHRISTINE ELWOOD | 810526 S HIGHWAY 177 CARNEY, OK 748324845 | AMERITAS LIFE INSURANCE CORP. | $591 | — | $591 | 10.00% |
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 | 131 | 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) | 131 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 155 | $704K |
| Dental | AFLAC | 53 | $56K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 61 | $6K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 131 | $81K |
| Short-term disability | AFLAC | 53 | $56K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 155 | $704K |
| Other(2 contracts, 2 carriers) | AFLAC | 131 | $81K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 155 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
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.