| 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 PO BOX 2147 OMAHA, NE 68103 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 0.41% |
| SMITH BOMAN & ASSOCIATES3 | 955 N STREET FRESNO, CA 93721 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $645 | — | $645 | 0.08% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: SOUTHWEST RISK MANAGEMENT LLC | 4801 E MCKELLIPS ROAD MESA, AZ 85215 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $430 | — | $430 | 0.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NATIONAL UNDERWRITING SERVICES STOP LOSS CARRIER | Other fees Service code 99 | 14893 S.H. 16 NORTH #1 HELOTES, TX 78023 | $138K |
| TRANSWESTERN INSURANCE ADMIN CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 45019 FRESNO, CA 93718 | $32K |
| SOUTHWEST RISK MANAGEMENT LLC BROKER | Insurance agents and brokers Service code 22 | 4801 E MCKELLIPS ROAD MESA, AZ 85215 | $30K |
| SMITH BOMAN & ASSOCIATES BROKER | Insurance agents and brokers Service code 22 | 955 N STREET FRESNO, CA 93721 | $5K |
| MULTIPLAN, INC PROVIDER CONTRACT | Other commissions Service code 55 | PO BOX 29380 NEW YORK, NY 10087 | $1K |
| PAYER COMPASS, LLC PROVIDER CONTRACT | Other commissions Service code 55 | 5800 GRANITE PARKWAY STE 450 PLANO, TX 75024 | $723 |
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 | 58 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 58 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $785K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $785K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $785K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $785K |
| Stop-loss / reinsurancereinsurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $785K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 0 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.