| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED BENEFITS GROUP LLC3 Filed as: DIVERSIFIED BENEFITS GROUP | 11725 ARBOR STREET STE 240 OMAHA, NE 68144 | BLUE CROSS AND BLUE SHIELD OF NEBRASKA | $43K | — | $43K | 2.04% |
| DIVERSIFIED BENEFITS GROUP LLC3 Filed as: DIVERSIFIED BENEFITS GROUP | 11725 ARBOR STREET STE 240 OMAHA, NE 68144 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 4.50% |
| KEITH A DERAS3 | C/O WILLIAMS-DERAS ASSOSCIATES 10040 REGENCY CIRCLE STE 345 OMAHA, NE 681143713 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | — | $3K | 13.31% |
| DIVERSIFIED BENEFITS GROUP LLC3 Filed as: DIVERSIFIED BENEFITS GROUP | 11725 ARBOR STREET STE 240 OMAHA, NE 68144 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 11.33% |
| DIVERSIFIED BENEFITS GROUP LLC3 Filed as: DIVERSIFIED BENEFITS GROUP | 11725 ARBOR STREET STE 240 OMAHA, NE 68144 | EYEMED | $1K | — | $1K | 8.74% |
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 | 130 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 135 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF NEBRASKA | 257 | $2.1M |
| Dental | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 120 | $62K |
| Vision | EYEMED | 280 | $14K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 135 | $15K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 114 | $21K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 135 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 280 | — |
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.