| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIRST INSURANCE GROUP LLC3 | DBA THE HARRY A. KOCH CO. 14010 FNB PARKWAY, SUITE 300 OMAHA, NE 68154 | COVENTRY HEALTH CARE OF NEBRASKA | $68K | — | $68K | 2.80% |
| FIRST INSURANCE GROUP LLC3 | DBA THE HARRY A KOCH CO 11949 Q ST OMAHA, NE 68137 | AETNA LIFE INSURANCE CO. | $4K | — | $4K | 0.50% |
| FIRST INSURANCE GROUP LLC3 Filed as: FIRST INSURANCE GROUP, LLC | 14010 FNB PKWY SUITE 300 OMAHA, NE 68145 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 9.59% |
| BENEFIT ADVISORS NETWORK LLC3 Filed as: BENEFIT ADVISORS NETWORK, LLC | 6830 COCHRAN ROAD SOLON, OH 44139 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $272 | $272 | 0.72% |
| FIRST INSURANCE GROUP LLC3 Filed as: FIRST INSURANCE GROUP, LLC | 14040 FNB PKWY SUITE 300 OMAHA, NE 68145 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 9.39% |
| BENEFIT ADVISORS NETWORK LLC3 | 6830 COCHRAN ROAD SOLON, OH 44139 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $154 | $154 | 0.71% |
| FIRST INSURANCE GROUP LLC3 | 14010 FNB PKWY SUITE 300 OMAHA, NE 68145 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 11.00% |
| BENEFIT ADVISORS NETWORK LLC3 | 6830 COCHRAN ROAD SOLON, OH 44139 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $110 | $110 | 0.71% |
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 | 422 | 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) | 422 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | COVENTRY HEALTH CARE OF NEBRASKA | 583 | $3.3M |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 539 | $22K |
| Short-term disability(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 400 | $53K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 583 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.