| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COTTINGHAM & BUTLER3 | 800 MAIN ST DUBUQUE, IA 52001 | WISCONSIN PHYSICIANS SERVICE INSURANCE COMPANY | $51K | — | $51K | 3.00% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SERVICES | 800 MAIN STREET DUBUQUE, IA 52001 | DELTA DENTAL OF NEW JERSEY, INC. | $23K | — | $23K | 9.99% |
| MSM GENERAL AGENCY INC3 Filed as: MSM GENERAL AGENCY | 2300 HYLAND BLVD. STE 2 STATEN ISLAND, NY 10306 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | — | $9K | 5.53% |
| EMPLOYEE BENEFIT PLANNING CONSULTAN3 | 290 WEST MONT PLEASANT AVE. LIVINGSTON, NJ 07039 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 5.36% |
| JBN BENEFITS CONSULTANTS LLC3 | 290 W MOUNT PLEASANT AVE STE 2300 LIVINGSTON, NJ 070392764 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 5.36% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SVCS | 800 MAIN ST DUBUQUE, IA 52001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8K | — | $8K | 8.39% |
| CAMERON SUTTON ROBERTS3 | N9404 ROSELLA DRIVE APPLETON, WI 54914 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $1K | $5K | 5.15% |
| DANIEL FROST3 | 241 POYGAN RD OMRO, WI 54963 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $342 | $4K | 3.88% |
| MAYNARD IRVIN HEBERT II3 | 106 CUMBERLYNN DR FOND DU LAC, WI 54935 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $137 | $1K | 1.49% |
| RODNEY JAMES SONNENBERG3 | 432 AMORY ST FOND DU LAC, WI 54935 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $328 | $70 | $398 | 0.42% |
| ROSE RODRIQUEZ CUEVAS3 | 1675 S FRANKWOOD AVE REEDLEY, CA 93654 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $348 | — | $348 | 0.37% |
| ADAM J ZAHN3 | 507 MAPLE RIDGE CT BLACK CREEK, WI 54106 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $322 | $1 | $323 | 0.34% |
| HELEN DIZ-HATTON3 | 4 PALMER LANE ENGLISHTOWN, NJ 07726 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $206 | — | $206 | 0.22% |
| THERESA NETTO PHILLIPS3 | 6219 S CLARA FRESNO, CA 93706 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $57 | $1 | $58 | 0.06% |
| AMY LYNN BRISKI3 | 1037 HARVEST TRL APPLETON, WI 54913 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $42 | — | $42 | 0.04% |
| BARRY W MAAS3 | PO BOX 5809 FRESNO, CA 93755 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $1 | $28 | 0.03% |
| LORI ANN BURNS3 | 1558 NORTH OXFORD AVE CLOVIS, CA 93654 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 0.03% |
| ARACELI GONZALES3 | 555 W SHAW AVENUE FRESNO, CA 93722 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.02% |
| MORGAN PERRI3 | 40 LEXINGTON CIR MARLTON, NJ 08053 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.01% |
| LAURIE J BURNS3 | 303 PLYLER RD INDIAN TRAIL, NC 28079 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.01% |
| KLD INSURANCE BENEFITS INC3 | 9085 BETHEL RD GAINSVILLE, GA 30506 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| NORMAC SOLUTIONS INC3 | 3730 EVEREST DR MONTGOMERY, AL 36106 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| SALATHIEL MALDONADO3 | 3717 CYPRESS AVE BROOKLYN, NY 11224 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| LISA A PERRI3 | 775 ROUTE 70 EAST MARLTON, NJ 08053 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| COTTINGHAM & BUTLER3 | 800 MAIN ST DUBUQUE, IA 52001 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | — | $2K | 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 | 279 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 282 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | WISCONSIN PHYSICIANS SERVICE INSURANCE COMPANY | 365 | $2.6M |
| Dental | DELTA DENTAL OF NEW JERSEY, INC. | 574 | $228K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 187 | $33K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 281 | $154K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 281 | $154K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 281 | $154K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 281 | $249K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 574 | — |
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."
No prospect flags tripped on this filing.