| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NONE | — | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | — | — | $0 | 0.00% |
| MICHAEL D BECKER3 | 4174 N RIVER RUN SAVAGE, MN 553782981 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 13.23% |
| MICHAEL D BECKER3 | 4174 N RIVER RUN SAVAGE, MN 553782981 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $566 | — | $566 | 10.00% |
| UNITED OF OMAHA LIFE INSURANCE CO0 Filed as: UNITED OF OMAHA LIFE INSURANCE COMP | 1650 W. 82ND STREET BLOOMINGTON, MN 55431 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | — |
| MICHAEL D BECKER3 | 4174 N RIVER RUN SAVAGE, MN 553782981 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $131 | — | $131 | — |
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 | 116 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 119 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 190 | $334K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $6K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $23K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 190 | $334K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 190 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.