| 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 PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | — |
| SMITH BOMAN & ASSOCIATES4 | 955 N STREET FRESNO, CA 93721 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $904 | — | $904 | — |
| ACRISURE LLC4 Filed as: DIBUDUO & DEFENDIS | P.O. BOX 5479 FRESNO, CA 93755 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $602 | — | $602 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NATIONAL UNDERWRITING SERVICES EIN 76-0168793 STOP LOSS CARRIER | Other fees Service code 99 | — | $77K |
| TRANSWESTERN INSURANCE ADMIN EIN 77-0118024 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $38K |
| SMITH BOMAN & ASSOCIATES EIN 94-2911577 BROKER | Insurance agents and brokers Service code 22 | — | $15K |
| DIBUDUO & DEDENDIS EIN 77-0107339 BROKER | Insurance agents and brokers Service code 22 | — | $14K |
| MULTIPLAN EIN 13-3068979 PROVIDER | Other fees Service code 99 | — | $10K |
| PAYERS COMPASS EIN 46-2047081 PROVIDER | Other fees Service code 99 | — | $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 | 192 | 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) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 192 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 192 | — |
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.