| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JBN BENEFITS CONSULTANTS LLC3 Filed as: JBN BENEFITS CONSULTANTS, LLC | 290 WEST MOUNT PLEASANT AVENUE SUITE 2300 LIVINGSTON, NJ 07039 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $25K | $0 | $25K | 11.38% |
| MSM GENERAL AGENCY INC3 Filed as: MSM GENERAL AGENCY, INC. | 2300 HYLAN BOULEVARD, SUITE 2 STATEN ISLAND, NY 10306 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $0 | $10K | 4.77% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INS. SERVICES | 800 MAIN STREET DUBUQUE, IA 52001 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $946 | $7K | 5.02% |
| CAMERON SUTTON ROBERTS3 | N9404 ROSELLA DRIVE APPLETON, WI 54915 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $604 | $5K | 3.27% |
| DANIEL FROST3 | 241 POYGAN ROAD OMRO, WI 54963 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $341 | $4K | 2.93% |
| MIH BENEFITS LLC3 Filed as: MIH BENEFITS, LLC | 106 CUMBERLYNN DRIVE FOND DU LAC, WI 54935 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $8 | $1K | 0.73% |
| RODNEY JAMES SONNENBERG3 | 432 AMORY STREET FOND AU LAC, WI 54935 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $168 | $3 | $171 | 0.11% |
| ADAM J ZAHN3 Filed as: ADAM J. ZAHN | 725 EAST GRANT STREET APPLETON, WI 54911 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $141 | $3 | $144 | 0.10% |
| HELEN DIZ-HATTON3 Filed as: HELEN DIZ-HATTON AND OTHER AGENTS | 4 PALMER LANE ENGLISHTOWN, NJ 07726 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $76 | $6 | $82 | 0.05% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER | 800 MAIN STREET DUBUQUE, IA 52001 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 3.18% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INS. SERVICES | 800 MAIN STREET DUBUQUE, IA 52001 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $877 | $4K | 13.67% |
| MIH BENEFITS LLC3 Filed as: MIH BENEFITS, LLC | 106 CUMBERLYNN DRIVE FOND DU LAC, WI 54935 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $682 | $3K | 9.61% |
| CAMERON SUTTON ROBERTS3 | N9404 ROSELLA DRIVE APPLETON, WI 54915 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $565 | $2K | 6.89% |
| DANIEL FROST3 | 241 POYGAN ROAD OMRO, WI 54963 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $139 | $0 | $139 | 0.49% |
| RODNEY JAMES SONNENBERG3 | 432 AMORY STREET FOND AU LAC, WI 54935 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.01% |
| DON GORDON CRONIN3 | 8545 MANSION HILL AVENUE APARTMENT 17 MADISON, WI 53719 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.01% |
| ADAM J ZAHN3 Filed as: ADAM J. ZAHN | 725 EAST GRANT STREET APPLETON, WI 54911 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.01% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER | 800 MAIN STREET DUBUQUE, IA 52001 | METROPOLITAN LIFE INSURANCE COMPANY | $770 | $0 | $770 | 5.74% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INS. SERVICES | 800 MAIN STREET DUBUQUE, IA 52001 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $596 | $136 | $732 | 7.40% |
| CAMERON SUTTON ROBERTS3 | N9404 ROSELLA DRIVE APPLETON, WI 54915 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $440 | $184 | $624 | 6.31% |
| ROSE RODRIGUEZ CUEVAS3 | 1675 SOUTH FRANKWOOD AVENUE REEDLEY, CA 93654 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $201 | $18 | $219 | 2.21% |
| THERESA NETTO PHILLIPS3 | 6219 SOUTH CLARA AVENUE FRESNO, CA 93706 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $0 | $20 | 0.20% |
| HELEN DIZ-HATTON3 | 4 PALMER LANE ENGLISHTOWN, NJ 07726 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $19 | $0 | $19 | 0.19% |
| BARRY W MAAS3 Filed as: BARRY W. MAAS | 1272 WEST MORAGA ROAD FRESNO, CA 93711 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $14 | $0 | $14 | 0.14% |
| RODNEY JAMES SONNENBERG3 | 432 AMORY STREET FOND AU LAC, WI 54935 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.02% |
| CAMERON SUTTON ROBERTS3 | N9404 ROSELLA DRIVE APPLETON, WI 54915 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $854 | $443 | $1K | 18.82% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INS. SERVICES | 800 MAIN STREET DUBUQUE, IA 52001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $779 | $227 | $1K | 14.60% |
| MIH BENEFITS LLC3 Filed as: MIH BENEFITS, LLC | 106 CUMBERLYNN DRIVE FOND DU LAC, WI 54935 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | $0 | $30 | 0.44% |
| MORGAN PERRI3 | 23 VOM EIGEN DRIVE MORRISTOWN, NJ 07960 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | $0 | $15 | 0.22% |
| WENDY ELIZABETH WESOLOWSKI3 | 1284 NORTH 12TH AVENUE PENSACOLA, FL 32503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | $0 | $10 | 0.15% |
| HELEN DIZ-HATTON3 | 4 PALMER LANE ENGLISHTOWN, NJ 07726 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.06% |
| MJ INSURANCE3 Filed as: LISA A. PERRI AND VARIOUS AGENTS | 775 ROUTE 70 EAST, SUITE F100 MARLTON, NJ 08053 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.04% |
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 | 296 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 308 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 514 | $3.6M |
| Vision(2 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 554 | $62K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 296 | $217K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 296 | $217K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 296 | $217K |
| Prescription drug(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 514 | $3.6M |
| Other(5 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 296 | $412K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 554 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.