| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHER A. BUMPS & ASSOCIATES, INC.3 Filed as: CHER A. BUMPS AND ASSOCIATES, INC. | 2601 NW EXPRESSWAY, SUITE 1000W OKLAHOMA CITY, OK 73112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 3.56% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 3856 SOUTH BOULEVARD EDMOND, OK 73013 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $919 | $9 | $928 | 4.60% |
| WILLIAM D STAEDKE3 Filed as: WILLIAM D. STAEDKE | 25695 EAST 71ST SOUTH BROKEN ARROW, OK 74014 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $623 | $53 | $676 | 3.35% |
| MARILYN K EMBERSON3 Filed as: MARILYN K. EMBERSON | 7220 NORTH HAMMOND AVENUE OKLAHOMA CITY, OK 73132 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $404 | $11 | $415 | 2.06% |
| KELLY W PUGH3 Filed as: KELLY W. PUGH | 7367 SOUTH 286TH EAST AVENUE BROKEN ARROW, OK 74014 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $197 | $2 | $199 | 0.99% |
| SHANNON MARIE BALDWIN3 | 10222 EAST 114TH STREET S BIXBY, OK 74008 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $145 | $3 | $148 | 0.73% |
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 | 150 | 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) | 150 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL | 112 | $52K |
| Vision | VISION SERVICE PLAN | 100 | $11K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $44K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $44K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $44K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 150 | $64K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 150 | — |
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.