| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MISSOURI, LLC | 404 W BROADWAY BLVD SEDALIA, MO 65301 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | — | $12K | 8.58% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF MISSOURI, LLC | 12645 OLIVE BLVD STE 300 SAINT LOUIS, MO 63141 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 3.60% |
| COPELAND FINL SVCS INC3 | 8013 OCEAN DRIVE FORT WORTH, TX 76123 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $123 | — | $123 | 2.67% |
| BROOKS TIMOTHY D3 | 2602 RIDGE RD STE 1 ROCKWALL, TX 75087 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $120 | — | $120 | 2.60% |
| CHARLIE MONEY INS SVCS INC3 | 3212 BARKWOOD LANE FRISCO, TX 75034 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $73 | — | $73 | 1.58% |
| FOUNDATION BENEFITS LLC3 | PO BOX 85 WEST, TX 76691 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $29 | — | $29 | 0.63% |
| PARHAM PATRICK3 | 6918 BLENHEIM DRIVE SPRING, TX 77379 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $29 | — | $29 | 0.63% |
| BBR & ASSOCIATES GROUP LLC3 | 8820 WILL CLAYTON PKWY SUITE F HUMBLE, TX 77338 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $15 | — | $15 | 0.33% |
| OSBURN ALFRED BEVLIE JR3 | PO BOX 1287 SHINER, TX 77984 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3 | — | $3 | 0.07% |
| POOLE PAMELA K3 | 4409 SOUTHBEND DRIVE FORTH WORTH, TX 76123 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3 | — | $3 | 0.07% |
| VESTAL GORDON C3 | 1317 RIVERCREST DRIVE MESQUITE, TX 75181 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3 | — | $3 | 0.07% |
| NBI & ASSOCIATES LLC3 | PO BOX 2529 588 BURLESON, TX 76097 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1 | — | $1 | 0.02% |
| ROGER GARZA3 | 2500 WILCREST #321 HOUSTON, TX 77042 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1 | — | $1 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CRUM & FORSTER TPA | Claims processing; Contract Administrator Service code 12 | 305 MADISON AVENUE MORRISTOWN, NJ 07962 | $288K |
| BOON CHAPMAN, LTD EIN 74-2305238 TPA | Consulting (general) Service code 16 | — | $44K |
| BEVCAP MANAGEMENT, LLC EIN 26-1870141 CONSULTING | Consulting (general) Service code 16 | — | $34K |
| BALDWIN GROUP EIN 76-0663719 BROKER | Insurance services; Insurance agents and brokers Service code 22 | — | $28K |
| AETNA-PPO EIN 06-6033492 ADMINISTRATOR | Insurance services; Plan Administrator Service code 14 | — | $21K |
| BEVCAP HEALTH CAPTIVE - NC EIN 26-1870141 ADMINISTRATOR | Plan Administrator Service code 14 | — | $13K |
| ASSUREDPARTNERS OF MISSOURI, LLC BROKER | Insurance agents and brokers; Insurance services Service code 22 | 12645 OLIVE BLVD STE 300 SAINT LOUIS, MO 63141 | $12K |
| WELLDYNERX, LLC TPA | Claims processing; Contract Administrator Service code 12 | 500 EAGLES LANDING DRIVE LAKELAND, FL 33810 | $7K |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 3 | $136K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 3 | $136K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 11 | $140K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 3 | $136K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 3 | $136K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 11 | $140K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 11 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.