| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SHANE JACOBSEN3 | 21436 LAKE HILL LN COUNCIL BLUFFS, IA 515032122 | METROPOLITAN LIFE INSURANCE COMPANY | $18K | — | $18K | 6.07% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 18100 VON KARMAN AVE STE 1000 DIRECT BILL DEPARTMENT IRVINE, CA 926127196 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $73 | $6K | 2.05% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INS SERVICES INC | PO BOX 745977 LOS ANGELES, CA 900745977 | METROPOLITAN LIFE INSURANCE COMPANY | — | $671 | $671 | 0.23% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INS SERVICES INC | 5444 WESTHEIMER RD STE 900 HOUSTON, TX 770565306 | METROPOLITAN LIFE INSURANCE COMPANY | — | $16 | $16 | 0.01% |
| SHANE JACOBSEN3 Filed as: SHANE L JACOBSEN | 102 PARKWILD DRIVE COUNCIL BLUFFS, IA 51503 | GEISINGER QUALITY OPTIONS, INC. | $8K | $30 | $8K | 3.20% |
| SHANE JACOBSEN3 Filed as: SHANE L JACOBSEN | 102 PARKWILD DRIVE COUNCIL BLUFFS, IA 51503 | GEISINGER HEALTH PLAN | $4K | $30 | $4K | 1.66% |
No Schedule C service providers reported on this filing.
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 | 320 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 320 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | GEISINGER QUALITY OPTIONS, INC. | 28 | $453K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 492 | $298K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 492 | $298K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 492 | $298K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 492 | $298K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 492 | $298K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 492 | $298K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 492 | — |
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."
No prospect flags tripped on this filing.