| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BERKLEY LIFE & HEALTH INS CO3 Filed as: BERKLEY LIFE AND HEALTH | 2445 KUSER ROAD SUITE 201 HAMILTON SQUARE, NJ 08690 | BERKLEY LIFE & HEALTH | — | $666K | $666K | 100.00% |
| LIFETIME BENEFITS INSURANCE LLP3 Filed as: LIFETIME BENEFITS INSURANCE, LLP | 400 NORTH MAIN STREET SUITE 103 GRAPEVINE, TX 76051 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $16K | $16K | 25.00% |
| LIFETIME BENEFITS INSURANCE LLP3 Filed as: LIFETIME BENEFITS INSURANCE, LLP | 400 NORTH MAIN STREET SUITE 103 GRAPEVINE, TX 76051 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 15.00% |
| LIFETIME BENEFITS INSURANCE LLP3 Filed as: LIFETIME BENEFITS INSURANCE, LLP | 400 NORTH MAIN STREET SUITE 103 GRAPEVINE, TX 76051 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFETIME BENEFITS EIN 94-3428547 BROKER | Insurance agents and brokers Service code 22 | 400 NORTH MAIN STREET SUITE 103 GRAPEVINE, TX 76051 | $177K |
| BENEFIT MANAGEMENT ADMINISTRATORS EIN 74-2666638 THIRD PARTY ADMINISTRATOR | Plan Administrator Service code 14 | 11550 IH 10 WEST SUITE 220 SAN ANTONIO, TX 78230 | $124K |
| MULTIPLAN, INC EIN 13-3068979 PPO NETWORK | Claims processing Service code 12 | 115 FIFTH AVENUE NEW YORK, NY 10003 | $17K |
| INETICO EIN 20-0457663 UTILIZATION FEE | Claims processing Service code 12 | P.O. BOX 10972 TAMPA, FL 33679 | $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 | 300 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 300 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 403 | $43K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 403 | $43K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 147 | $63K |
| Stop-loss / reinsurancereinsurance | BERKLEY LIFE & HEALTH | 300 | $666K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 403 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.