| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNITED OF OMAHA LIFE INSURANCE CO0 Filed as: UNITED OF OMAHA INSURANCE COMPANY | MUTUAL OF OMAHA COMPANIES OMAHA, NE 68103 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | — |
| SMITH BOMAN & ASSOCIATES0 | 955 N STREET FRESNO, CA 93721 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | — |
| RELATION INSURANCE SERVICES OF CA0 Filed as: RELATION INSURANCE SERVICES | 80 S LAKE AVENUE STE 600 PASADENA, CA 91101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $627 | — | $627 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRANSWESTERN INSURANCE ADMIN EIN 77-0118024 CONTRACT ADMIN | Contract Administrator Service code 13 | 955 N STREET FRESNO, CA 93721 | $38K |
| DR PAYAN CONTRACT PROVIDER | Other fees Service code 99 | — | $25K |
| NATIONAL UNDERWRITING SERVICES EIN 76-0168793 STOP-LOSS CARRIER | Other fees Service code 99 | 14893 S.H. 16 NORTH #1 HELOTES, TX 78023 | $11K |
| RELATION INSURANCE SERVICES EIN 26-1441725 BROKER | Insurance agents and brokers Service code 22 | 80 S LAKE AVENUE STE 600 PASADENA, CA 91101 | $9K |
| SMITH BOMAN & ASSOCIATES EIN 94-2911577 BROKER | Insurance agents and brokers Service code 22 | 955 N STREET FRESNO, CA 93721 | $2K |
| MICHAEL PAGE BROKER | Insurance agents and brokers Service code 22 | 2866 W 13TH PL YUMA, AZ 85364 | $848 |
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 | 106 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 106 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 106 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.