Form 5500 · Employee benefit plan · BURWELL, NE
SUBCONN, INC
The filing calls this plan SUBCONN, INC HEALTH AND WELFARE PLAN.
Public Form 5500 records show how SUBCONN, INC of BURWELL, NE, a manufacturing employer, structures its employee benefits. Its broker of record is PATRIOT GROWTH. Coverage is written through BLUE CROSS BLUE SHIELD OF NEBRASKA and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 47-0817656 · plan 504 · plan year 2025, filed Aug 18, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 3 insured contracts covering health, dental, vision and life; the largest, with BLUE CROSS BLUE SHIELD OF NEBRASKA, covers 142 people.
Reported premium across the insured contracts is $1,006,995, with $36,237 in disclosed broker commissions — about 3.6% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
PATRIOT GROWTH is the broker of record on 1 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including BLUE CROSS BLUE SHIELD OF NEBRASKA, AMERITAS LIFE INSURANCE CORP. and UNITED OF OMAHA LIFE INSURANCE COMPANY. BLUE CROSS BLUE SHIELD OF NEBRASKA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF NEBRASKA | Health | 142 | Jan 1, 2026 | $943,433 | $29,880 |
| AMERITAS LIFE INSURANCE CORP. | Dental, Vision | 149 | Jan 1, 2026 | $59,146 | $5,915 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 104 | Jan 1, 2026 | $4,416 | $442 |
Premium and claims on this contract
BLUE CROSS BLUE SHIELD OF NEBRASKA, contract 110844. For the contract year on this filing, the carrier reported $943,433 in premium earned and $954,077 in claims incurred. Dividing one by the other gives 101%.
- BLUE CROSS BLUE SHIELD OF NEBRASKA, contract 110844 reported $104,670 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 124 employees, 4 recordable cases, 11 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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