| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE SERVICES 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | — | $8K | 3.51% |
| OCI INSURANCE & FINANCIAL SERVICES3 Filed as: OCI INS AND FINANCIAL SERVICES | 4221 N 203RD ST STE 200 ELKHORN, NE 68022 | PRINCIPAL LIFE INSURANCE COMPANY | — | $3K | $3K | 1.36% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3110 E GUASTI RD STE 500 ONTARIO, CA 91761 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 0.73% |
| ACRISURE LLC3 | PO BOX 1788 GRAND RAPIDS, MI 49501 | PRINCIPAL LIFE INSURANCE COMPANY | — | $1K | $1K | 0.48% |
| ADP INC5 Filed as: AUTOMATIC DATA PROCESSING INC | PO BOX 842875 BOSTON, MA 02284 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $10K | $10K | 15.36% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 11.07% |
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: BLUE CROSS AND BLUE SHIELD OF | NEBRASKA 1919 AKSARBEN DR OMAHA, NE 68180 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 8.42% |
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: BLUE CROSS AND BLUE SHIELD OF | NEBRASKA 1919 AKSARBEN DR OMAHA, NE 68180 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 7.71% |
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: BLUE CROSS AND BLUE SHIELD OF | NEBRASKA 1919 AKSARBEN DR OMAHA, NE 68180 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 9140 E HAMILTON AVE #410 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 8.22% |
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: BLUE CROSS AND BLUE SHIELD OF | NEBRASKA 1919 AKSARBEN DR OMAHA, NE 68180 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 5.00% |
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 | 249 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 253 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF NEBRASKA | 487 | $201K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 613 | $220K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 613 | $220K |
| Life insurance(3 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 613 | $338K |
| Short-term disability(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 613 | $266K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 253 | $54K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 255 | $118K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 613 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.