| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | PO BOX 3430 CARMEL, IN 46082 | AMERITAS LIFE INSURANCE CORP. | $57K | $11K | $67K | 17.85% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 3900 EAST CAMELBACK ROAD SUITE 225 PHOENIX, AZ 85018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $29K | $2K | $31K | 15.80% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 3900 EAST CAMELBACK ROAD SUITE 225 PHOENIX, AZ 85018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $21K | $887 | $22K | 15.65% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 3900 EAST CAMELBACK ROAD SUITE 225 PHOENIX, AZ 85018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $18K | $1K | $19K | 15.93% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 3900 EAST CAMELBACK ROAD SUITE 225 PHOENIX, AZ 85018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $18K | $748 | $18K | 15.64% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 3900 EAST CAMELBACK ROAD SUITE 225 PHOENIX, AZ 85018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | $769 | $12K | 16.00% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 3900 EAST CAMELBACK ROAD SUITE 225 PHOENIX, AZ 85018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $432 | $9K | 15.79% |
| FMLASOURCE INC5 Filed as: FMLASOURCE INC. | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $5K | $5K | 8.91% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995275 CLAIM PROCESSOR | Claims processing Service code 12 | — | $193K |
| MJ INSURANCE INC. EIN 35-1109367 BROKER | Other commissions Service code 55 | — | $169K |
| HEALTHJOY LLC UTILIZATION REVIEW | Other services Service code 49 | 215 W SUPERIOR ST 5TH FLOOR CHICAGO, IL 60654 | $11K |
| PHCS EIN 04-3138814 PPO NETWORK | Other services Service code 49 | — | $8K |
| ALLIED BENEFIT SYSTEMS INC. EIN 36-3086057 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $3K |
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 | 553 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 555 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP. | 1,122 | $377K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 1,122 | $377K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 825 | $132K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 51 | $137K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 196 | $117K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 398 | $820K |
| Other(5 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP. | 1,122 | $821K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,122 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.