| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COTTINGHAM & BUTLER3 | 800 MAIN ST DUBUQUE, IA 52001 | WISCONSIN PHYSICIANS SERVICE INSURANCE COMPANY | $41K | — | $41K | 3.60% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INSURANCE SERVI | 800 MAIN STREET DUBUQUE, IA 52004 | DELTA DENTAL OF NJ, INC. | $20K | — | $20K | 10.00% |
| MSM GENERAL AGENCY INC3 Filed as: MSM GENERAL AGENCY | 2300 HYLAND BLVD. STE 2 STATEN ISLAND, NY 10306 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 5.53% |
| EMPLOYEE BENEFIT PLANNING CONSULTAN3 | 290 WEST MONT PLEASANT AVE. LIVINGSTON, NJ 07039 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 5.37% |
| JBN BENEFITS CONSULTANTS LLC3 | 290 W MOUNT PLEASANT AVE STE 2300 LIVINGSTON, NJ 070392764 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 5.37% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SVCS | 800 MAIN ST DUBUQUE, IA 52001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.93% |
| CAMERON SUTTON ROBERTS3 | N9404 ROSELLA DRIVE APPLETON, WI 54914 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $560 | $63 | $623 | 2.00% |
| ROSE RODRIQUEZ CUEVAS3 | 1675 S FRANKWOOD AVE REEDLEY, CA 93654 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $576 | $16 | $592 | 1.90% |
| ARACELI GONZALES3 | 555 W SHAW AVENUE FRESNO, CA 93722 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $126 | — | $126 | 0.40% |
| HELEN DIZ-HATTON3 | 4 PALMER LANE ENGLISHTOWN, NJ 07726 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $122 | — | $122 | 0.39% |
| THERESA NETTO PHILLIPS3 | 6219 S CLARA FRESNO, CA 93706 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $95 | $8 | $103 | 0.33% |
| BARRY W MAAS3 | PO BOX 5809 FRESNO, CA 93755 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $53 | $16 | $69 | 0.22% |
| LORI ANN BURNS3 | 1558 NORTH OXFORD AVE CLOVIS, CA 93654 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.10% |
| LAURIE J BURNS3 | 303 PLYLER RD INDIAN TRAIL, NC 28079 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.05% |
| RODNEY JAMES SONNENBERG3 | 432 AMORY ST FOND DU LAC, WI 54935 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.04% |
| KLD INSURANCE BENEFITS INC3 | 9085 BETHEL RD GAINSVILLE, GA 30506 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| NORMAC SOLUTIONS INC3 | 3730 EVEREST DR MONTGOMERY, AL 36106 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| COTTINGHAM & BUTLER3 | 800 MAIN ST DUBUQUE, IA 52001 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC | $1K | — | $1K | 7.00% |
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 | 256 | 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) | 256 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | WISCONSIN PHYSICIANS SERVICE INSURANCE COMPANY | 324 | $2.0M |
| Dental | DELTA DENTAL OF NJ, INC. | 229 | $205K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC | 82 | $15K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 256 | $140K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 256 | $140K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 256 | $140K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 256 | $171K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 324 | — |
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.