| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BERKLEY LIFE & HEALTH INS CO3 Filed as: BERKLEY LIFE & HEALTH INSURANCE | 2445 KUSER ROAD SUITE 201 HAMILTON SQUARE, NJ 08690 | BERKLEY LIFE & HEALTH INSURANCE | $0 | $597K | $597K | 100.00% |
| LIFETIME BENEFITS INSURANCE LLP3 Filed as: LIFETIME BENEFITS INSURANCE | 400 NORTH MAIN STREET SUITE 103 GRAPEVINE, TX 76051 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $16K | $16K | 25.00% |
| LIFETIME BENEFITS INSURANCE LLP3 Filed as: LIFETIME BENEFITS INSURANCE | 400 NORTH MAIN STREET SUITE 103 GRAPEVINE, TX 76051 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 15.00% |
| LIFETIME BENEFITS INSURANCE LLP3 Filed as: LIFETIME BENEFITS INSURANCE | 400 NORTH MAIN STREET SUITE 103 GRAPEVINE, TX 76051 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 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 | $160K |
| BENEFIT MANAGEMENT ADMINISTRATORS EIN 74-2666638 THIRD PARTY ADMINISTRATOR | Plan Administrator Service code 14 | 11550 IH 10 WEST SUITE 220 SAN ANTONIO, TX 78230 | $128K |
| CWI BENEFITS EIN 54-0870204 PPO NETWORK | Claims processing Service code 12 | PO BOX 6125 GREENVILLE, SC 29606 | $65K |
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 | 299 | 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) | 299 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BERKLEY LIFE & HEALTH INSURANCE | 299 | $597K |
| Dental | BERKLEY LIFE & HEALTH INSURANCE | 299 | $597K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 400 | $39K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 400 | $39K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 143 | $62K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 400 | — |
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.