| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARYL PRIBYL3 | 14301 FNB PARKWAY SUITE 100 OMAHA, NE 68154 | BLUECROSS BLUESHIELD OF NEBRASKA | $38K | — | $38K | 4.19% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY, INC.-ROCHESTER | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | HUMANA INSURANCE COMPANY | $3K | $337 | $4K | 7.78% |
| GREGORY & APPEL, INC.3 Filed as: GREGORY S.DENSON | 2150 S. CENTRAL EXPRESSWAY SUITE 2 MCKINNEY, TX 75070 | HUMANA INSURANCE COMPANY | $436 | — | $436 | 0.91% |
| PAYCHEX INSURANCE AGENCY, INC.3 | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | AMERITAS LIFE INSURANCE COMPANY | $717 | $117 | $834 | 7.82% |
| EARN OUT BOUND LLC3 | 2150 S. CENTRAL EXPRESSWAY SUITE 280 MCKINNEY, TX 75070 | AMERITAS LIFE INSURANCE COMPANY | $350 | — | $350 | 3.28% |
| TIMOTHY H OLSON3 Filed as: TIMOTHY H. OLSON | 16820 FRANCES STREET SUITE 202 OMAHA, NE 68130 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $952 | — | $952 | 19.00% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH DBA TIM OLSON I | 16820 FRANCES STREET SUITE 202 OMAHA, NE 68130 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $120 | $120 | 2.39% |
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 | 139 | 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) | 139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF NEBRASKA | 158 | $917K |
| Dental(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF NEBRASKA | 158 | $965K |
| Vision | AMERITAS LIFE INSURANCE COMPANY | 198 | $11K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 44 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 198 | — |
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.