| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JONES INSURANCE AGENCY INC3 Filed as: JONES INSURANCE AGENCY | 1831 N 4TH STREET DAVID CITY, NE 68632 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| JONES INSURANCE AGENCY INC3 Filed as: JONES INSURANCE AGENCY | 1831 N 4TH STREET DAVID CITY, NE 68632 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGIONAL CARE, INC. EIN 47-0760050 TPA | Claims processing Service code 12 | 905 WEST 27TH STREET SCOTTSBLUFF, NE 69361 | $44K |
| JONES INSURANCE AGENCY INC. EIN 47-0766210 BROKER | Insurance agents and brokers Service code 22 | 1831 N 4TH STREET DAVID CITY, NE 68632 | $38K |
| PARTNERS HEALTH ALLIANCE LLC EIN 47-2739227 INSURANCE SERVICES | Insurance agents and brokers Service code 22 | 106 WEST 3RD ST PO BOX 488 MCCOOK, NE 69001 | $11K |
| MULTI PLAN INC. EIN 13-3068979 PPO | Insurance services Service code 23 | PO BOX 29380 NEW YORK CITY, NY 10087 | $9K |
| PHIA GROUP CONSULTING EIN 46-1439866 CONSULTING | Consulting (general) Service code 16 | 40 PEQUOT WAY CANTON, MA 02021 | $9K |
| AMERITAS EIN 47-0098400 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 81889 LINCOLN, NE 68501 | $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 | 126 | 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) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | WESTERN SKIES | 0 | $572K |
| Dental | WESTERN SKIES | 0 | $572K |
| Vision | WESTERN SKIES | 0 | $572K |
| Life insurance(3 contracts, 2 carriers) | WESTERN SKIES | 97 | $609K |
| Short-term disability(2 contracts, 2 carriers) | WESTERN SKIES | 97 | $582K |
| Long-term disability | WESTERN SKIES | 0 | $572K |
| Prescription drug | WESTERN SKIES | 0 | $572K |
| Stop-loss / reinsurancereinsurance | WESTERN SKIES | 0 | $572K |
| Other | WESTERN SKIES | 0 | $572K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 97 | — |
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.