| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COTTINGHAM & BUTLER3 | 800 MAIN STREET PO BOX 28 DUBUQUE, IA 52004 | NETWORK HEALTH PLAN | $36K | $6K | $42K | 3.18% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INSURANCE SERVI | 800 MAIN STREET DUBUQUE, IA 52004 | DELTA DENTAL OF NJ, INC. | $19K | — | $19K | 10.43% |
| MSM GENERAL AGENCY INC3 Filed as: MSM GENERAL AGENCY | 2300 HYLAND BLVD. STE 2 STATEN ISLAND, NY 10306 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 5.58% |
| EMPLOYEE BENEFIT PLANNING CONSULTAN3 | 290 WEST MONT PLEASANT AVE. LIVINGSTON, NJ 07039 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 5.42% |
| JBN BENEFITS CONSULTANTS LLC3 | 290 W MOUNT PLEASANT AVE STE 2300 LIVINGSTON, NJ 070392764 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 5.42% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM I BUTLER INS SVCS | 800 MAIN ST DUBUQUE, IA 52001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17K | — | $17K | 27.58% |
| CAMERON SUTTON ROBERTS3 | N9404 ROSELLA DRIVE APPLETON, WI 54914 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $5K | $11K | 18.38% |
| ROSE RODRIQUEZ CUEVAS3 Filed as: ROSE RODRQUEZ CUEVAS | 1675 S FRANKWOOD AVE REEDLEY, CA 93654 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $270 | $4K | 6.10% |
| MAYNARD IRVIN HEBERT II3 | 439 ELLIS STREET FOND DU LAC, WI 54935 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $442 | $3K | 5.11% |
| HELEN DIZ-HATTON3 | 4 PALMER LANE ENGLISHTOWN, NJ 07726 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $750 | $2K | 3.33% |
| LORI ANN BURNS3 | 1558 NORTH OXFORD AVE CLOVIS, CA 93619 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $114 | $2K | 3.00% |
| SALATHIEL MALDONADO3 | 3717 CYPRESS AVE BROOKLYN, NY 11224 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $263 | $1K | $1K | 2.11% |
| THERESA NETTO PHILLIPS3 | 6219 S CLARA FRESNO, CA 93755 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $883 | $182 | $1K | 1.73% |
| BARRY W MAAS3 | PO BOX 5809 FRESNO, CA 93755 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $581 | $431 | $1K | 1.64% |
| ISAAC TODD WILDA3 | 1602 N RYNDERS ST APPLETON, WI 54914 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $490 | $71 | $561 | 0.91% |
| AARON R. RANKINEN3 Filed as: AARON RANKINEN | W5008 GOLF COURSE RD SHERWOOD, WI 54169 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $371 | $124 | $495 | 0.80% |
| RODNEY JAMES SONNENBERG3 | 1591/2 4TH ST FOND DU LAC, WI 54935 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $354 | $85 | $439 | 0.71% |
| ADAM J ZAHN3 Filed as: ADAM ZAHN | 507 MAPLE RIDGE CT BLACK CREEK, WI 54106 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $164 | $40 | $204 | 0.33% |
| JOSEPH DAVIS3 Filed as: JOSEPH H DAVIS | 65 MECHANIC STREET SUITE 205 RED BANK, NJ 07731 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $160 | — | $160 | 0.26% |
| LAURA J BURNS3 | 303 PLYLER ROAD INDIAN TRAILS, NC 28079 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $37 | $17 | $54 | 0.09% |
| BRIAN THOMAS CULLEN3 | 370 LEXINGTON AVENUE NEW YORK, NY 10017 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | $22 | $41 | 0.07% |
| KID INSURANCE BENEFITS INC3 | 8045 ROYAL SAINT GEORGES LANE DULUTH, GA 30097 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $11 | $19 | 0.03% |
| NORMAC SOLUTIONS INC3 | 3730 EVEREST DR MONTGOMERY, AL 36106 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $3 | $11 | 0.02% |
| COTTINGHAM & BUTLER3 | 800 MAIN ST DUBUQUE, IA 52001 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC | $2K | — | $2K | 7.63% |
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 | 271 | 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) | 271 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | NETWORK HEALTH PLAN | 181 | $2.2M |
| Dental | DELTA DENTAL OF NJ, INC. | 222 | $179K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC | 326 | $23K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 240 | $112K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 240 | $112K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 240 | $112K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 240 | $173K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 326 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.