| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DAN SCHWARTZKOPF - KRULL AGENCY INC3 | 2837 WEST HWY 6, SUITE 203 HASTINGS, NE 68901 | AIG BENEFIT SOLUTIONS | $4K | — | $4K | 10.00% |
| RALPH H KEELER3 Filed as: RALPH KEELER | 8716 RIVERDALE RD PLATTSMOUTH, NE 68048 | ALLSTATE | $1K | — | $1K | 6.75% |
| UNICO GROUP INC3 | 4435 O ST STE 200 LINCOLN, NE 68510 | ALLSTATE | $506 | — | $506 | 3.04% |
| KEELER & ASSOCIATES3 Filed as: KEELER AND ASSOCIATES | 2209 1ST AVE PLATTSMOUTH, NE 68048 | ALLSTATE | $175 | — | $175 | 1.05% |
| JOANN R MEYER3 | PO BOX 540874 LINCOLN, NE 68154 | ALLSTATE | $7 | — | $7 | 0.04% |
| MID AMERICAN INSURANCE GROUP3 Filed as: MID-AMERICAN INSURANCE GROUP | 5310 N 99TH ST STE 1 OMAHA, NE 68134 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 12.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MID-AMERICAN BENEFITS INC EIN 47-0769922 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 5310 NORTH 99TH ST SUITE 1 OMAHA, NE 68134 | $33K |
| DAN SCHWARTZKOPF, KRULL AGENCY INC EIN 47-0777401 INSURANCE BROKER | Insurance agents and brokers Service code 22 | 2837 WEST HWY 6 SUITE 203 HASTINGS, NE 68901 | $12K |
| MIDLANDS CHOICE EIN 47-0804331 PPO | Claims processing Service code 12 | PO BOX 5809 TROY, MI 48007 | $10K |
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 | 180 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 180 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BERKLEY LIFE & HEALTH COMPANY | 180 | $233K |
| Dental | BERKLEY LIFE & HEALTH COMPANY | 180 | $216K |
| Life insurance(3 contracts, 3 carriers) | BERKLEY LIFE & HEALTH COMPANY | 180 | $243K |
| Prescription drug | BERKLEY LIFE & HEALTH COMPANY | 180 | $216K |
| Stop-loss / reinsurancereinsurance | BERKLEY LIFE & HEALTH COMPANY | 180 | $216K |
| Other | AIG BENEFIT SOLUTIONS | 180 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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."
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.