| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE PLEXUS GROUPE LLC3 | 21805 FIELD PARKWAY SUITE 300 DEER PARK, IL 60010 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $201K | $38K | $239K | 19.78% |
| PAYCOM PAYROLL LLC5 | 7501 W MEMORIAL RD OKLAHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $42K | — | $42K | 3.50% |
| FMLASOURCE INC5 | 455 N CITYFRONT PLZ DR 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $31K | $31K | 2.54% |
| THE PLEXUS GROUPE LLC3 | 21805 FIELD PARKWAY SUITE 300 DEER PARK, IL 60010 | UNITEDHEALTHCARE INSURANCE COMPANY | $108K | — | $108K | 10.64% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $1.1M |
| TOTAL ADMINISTRATIVE SERVICES CORP EIN 39-1561025 ADMINISTRATOR | Contract Administrator Service code 13 | — | $15K |
| THE PLEXUS GROUPE LLC EIN 36-4116295 BROKER | Other commissions Service code 55 | — | $0 |
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 | 2,225 | 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) | 2,225 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 2,826 | $1.0M |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 2,826 | $1.0M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 2,225 | $1.2M |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 2,225 | $1.2M |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 2,225 | $1.2M |
| Stop-loss / reinsurancereinsurance | WESTPORT INSURANCE CORPORATION | 1,607 | $900K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 2,225 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,826 | — |
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.