| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JEFFREY T KELSEY3 | KELSEY BENEFITS GROUP 5057 S 1500 W RIVERDALE, UT 84405 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 9.75% |
| INTERMOUNTAIN INSURANCE SERVICES3 | 5075 S 1500 W RIVERDALE, UT 84405 | USABLE LIFE | $898 | $250 | $1K | 21.78% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MERITAIN HEALTH EIN 16-1264154 NONE | Insurance brokerage commissions and fees; Contract Administrator; Other insurance fees and expenses Service code 13 | — | $106K |
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. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 249 | $55K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 249 | $50K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | SWISS RE CORPORATE SOLUTIONS AMERICA INS. CORP. | 249 | $324K |
| Other | USABLE LIFE | 221 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 249 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.