| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| APRIL MARIE HUDGENS3 | PO BOX 450053 GROVE, OK 74345 | AFLAC | $2K | $115 | $2K | 4.53% |
| M JOANNE BLEVINS3 | PO BOX 1436 MIAMI, OK 74355 | AFLAC | $822 | — | $822 | 1.70% |
| DEREK J COMAGES3 | 631-5 HC 60 BOX CHECOTAH, OK 74426 | AFLAC | $503 | $23 | $526 | 1.09% |
| TRAVIS D HURT3 | 18446 S 154TH EAST AVE BIXBY, OK 74008 | AFLAC | $520 | — | $520 | 1.08% |
| MICHAEL ARTHUR KIRK3 | 9726 E 42ND ST STE 201 TULSA, OK 74146 | AFLAC | $507 | — | $507 | 1.05% |
| SHIRLEY A BAZAY3 | 5150 BROADWAY ST 156 SAN ANTONIO, TX 78209 | AFLAC | $348 | — | $348 | 0.72% |
| GENA GRACE QUARANTELLO3 | 12962 E VISTAPARK DR MOORPARK, CA 93021 | AFLAC | $321 | — | $321 | 0.66% |
| IAGENTTCB LLC3 | 14911 S 4220 RD CLAREMORE, OK 74017 | AFLAC | $288 | — | $288 | 0.60% |
| DARREN R WARREN3 | 13504 N 2320 RD GOTEBO, OK 73041 | AFLAC | $271 | — | $271 | 0.56% |
| JOHN ROBERT DE LARIOS3 | 119 TAMAROCK CV HOLLY LAKE RANCH, TX 75765 | AFLAC | $259 | — | $259 | 0.54% |
| JAMES D GRACE3 | 2482 W NEW ORLEANS ST BROKEN ARROW, OK 74011 | AFLAC | $214 | $23 | $237 | 0.49% |
| LARRY D DENNY3 | PO BOX 306 WETUMKA, OK 74883 | AFLAC | $192 | — | $192 | 0.40% |
| KELLI R CAROTHERS3 | 7310 E 76TH ST TULSA, OK 74133 | AFLAC | $105 | — | $105 | 0.22% |
| LINDA M SMITH3 | PO BOX 451736 GROVE, OK 74345 | AFLAC | $96 | — | $96 | 0.20% |
| LYNDA F BENGE3 | 7434 E 83RD PLACE TULSA, OK 74133 | AFLAC | $95 | — | $95 | 0.20% |
| ELAINE HAMMAR3 | 7922 S 78TH EAST AVE TULSA, OK 74133 | AFLAC | $79 | — | $79 | 0.16% |
| LESTER RAY BLACKSHEAR3 | 8545 SW 86TH TER OCALA, FL 34481 | AFLAC | $46 | — | $46 | 0.10% |
| DAVID L DEARDORFF3 | 9083 E 138TH ST S BIXBY, OK 74008 | AFLAC | $32 | — | $32 | 0.07% |
| LESLIE J BAILEY3 | 4234 N PORTAGE AVE MERIDIAN, ID 83646 | AFLAC | $29 | — | $29 | 0.06% |
| GENA G QUARANTELLO3 | 12962 E VISTAPARK DR MOORPARK, CA 93021 | AFLAC | $18 | — | $18 | 0.04% |
| CARL CLARK3 | 1410 CEDAR ST BARTLESVILLE, OK 74006 | AFLAC | $15 | — | $15 | 0.03% |
| JOHN A WILLIAMS COMPANY INC3 | 20316 N COUNTY ROAD 3240 PAULS VALLEY, OK 73075 | AFLAC | $13 | — | $13 | 0.03% |
| JARRELL K PRENTICE3 | 1113 EAST DR EDMOND, OK 73034 | AFLAC | $13 | — | $13 | 0.03% |
| MOFFATT DESIGNS LLC3 | 1221 LAMPLIGHTER LANE EDMOND, OK 73034 | AFLAC | $12 | — | $12 | 0.02% |
| EDWARD A HALL JR3 | 15 VILLAGE PARK DR NEWNAN, GA 30265 | AFLAC | $9 | — | $9 | 0.02% |
| SHANE M OWEN3 | 3000 UNITED FOUNDERS BLVD STE 248 OKLAHOMA CITY, OK 73112 | AFLAC | $8 | — | $8 | 0.02% |
| STEPHEN W SIMPSON3 | 541 CONQUISTADOR CT EDMOND, OK 73025 | AFLAC | $5 | — | $5 | 0.01% |
| DOUGLAS E FOX3 | 735 S GARFIELD AVE STE 203 TRAVERSE CITY, MI 49686 | AFLAC | $4 | — | $4 | 0.01% |
| JOSHUA C ROLAN3 | 704 SEMINOLE DR PAULS VALLEY, OK 73075 | AFLAC | $2 | — | $2 | 0.00% |
| JAMES D DUDLEY3 | 1355 LYNNFIELD RD STE 259 MEMPHIS, TN 381195843 | AFLAC | $1 | — | $1 | 0.00% |
| PAUL B BROUCHOUD3 | 604 MARK DR DEL CITY, OK 73115 | AFLAC | $1 | — | $1 | 0.00% |
| DAN CROSS3 | 516 SUNSET PL CHARLES CITY, IA 50616 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 8.80% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT MANAGEMENT, INC. EIN 43-1788340 THIRD PARTY ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $55K |
| FIRST HEALTH GROUP EIN 20-1736437 PPO | Contract Administrator; Claims processing Service code 12 | — | $10K |
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 | 162 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED STATES FIRE INSURANCE COMPANY | 162 | $156K |
| Dental | UNITED STATES FIRE INSURANCE COMPANY | 162 | $156K |
| Vision | UNITED STATES FIRE INSURANCE COMPANY | 162 | $156K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 171 | $18K |
| Stop-loss / reinsurancereinsurance | UNITED STATES FIRE INSURANCE COMPANY | 162 | $156K |
| Other(2 contracts, 2 carriers) | AFLAC | 171 | $66K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 171 | — |
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.