| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $73 | $73 | 0.02% |
| BANCFIRST INSURANCE SERVICES, INC.3 | 220 EAST 8TH STREET, SUITE B TULSA, OK 74119 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $17 | $17 | 0.01% |
| BANCFIRST INSURANCE SERVICES, INC.3 | 220 EAST 8TH STREET, SUITE B TULSA, OK 74119 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 10.00% |
| BANCFIRST INSURANCE SERVICES, INC.3 | 13230 PAWNEE DRIVE OKLAHOMA CITY, OK 73114 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12K | $0 | $12K | 15.94% |
| WILLIAM D STAEDKE3 Filed as: WILLIAM D. STAEDKE | PO BOX 140803 BROKEN ARROW, OK 74014 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10K | $949 | $11K | 15.57% |
| KELLY W PUGH3 Filed as: KELLY W. PUGH | 7367 SOUTH 286TH EAST AVENUE BROKEN ARROW, OK 74014 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $38 | $2K | 2.07% |
| LVI BENEFITS SERVICES LLC3 Filed as: LVI INSURANCE SERVICES, LLC | 2985 SURREY RIDGE ROAD CLARKSVILLE, TN 37043 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $0 | $12 | 0.02% |
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 | 667 | 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) | 667 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 489 | $74K |
| Life insurance(2 contracts, 2 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,364 | $630K |
| Short-term disability(2 contracts, 2 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,364 | $630K |
| Long-term disability(2 contracts, 2 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,364 | $630K |
| Other(3 contracts, 3 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,364 | $704K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,364 | — |
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.