| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN RISK MANAGEMENT, LLC4 Filed as: ASG RISK MANAGMENT | TWO MONUMENT SQUARE PORTLAND, ME 04101 | COMPANION LIFE | — | — | $0 | 0.00% |
| CROWN RISK MANAGEMENT, LLC4 Filed as: ASG RISK MANAGEMENT | TWO MONUMENT SQUARE PORTLAND, ME 04101 | COMPANION LIFE | — | — | $0 | 0.00% |
| REGIONAL CARE INC4 Filed as: REGIONAL CARE, INC | 905 WEST 27TH STREET SCOTTSBLUFF, NE 69361 | UNITED HEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGIONAL CARE, INC. EIN 47-0760050 TPA | Claims processing Service code 12 | 905 WEST 27TH STREET SCOTTSBLUFF, NE 69361 | $29K |
| STRONG FINANCIAL RESOURCES EIN 47-0846336 BROKER | Insurance agents and brokers Service code 22 | 1611 10TH STREET AURORA, NE 68818 | $15K |
| MIDLANDS CHOICE EIN 47-0804331 PPO NETWORK | Insurance services Service code 23 | 8420 W DODGE RD, STE 210 OMAHA, NE 68114 | $8K |
| MEDTRAK SEVICES LLC EIN 36-4221427 TPA | Claims processing Service code 12 | 7101 COLL. BLVD, STE 1000 OVERLAND PARK, KS 66210 | $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 | 142 | 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) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMPANION LIFE | 142 | $234K |
| Other | UNITED HEALTHCARE INSURANCE COMPANY | 275 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 275 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.