| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INSURANCE SERVI | 2340 S DES PLAINES RIVER ROAD SUITE 303 DES PLAINES, IL 60018 | UNITEDHEALTHCARE INSURANCE COMPANY | $0 | -$31 | -$31 | -0.00% |
| JBN BENEFITS CONSULTANTS LLC3 | 290 W MOUNT PLEASANT AVE STE 2300 LIVINGSTON, NJ 07039 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $34K | — | $34K | 10.97% |
| MSM GENERAL AGENCY INC3 | 2300 HYLAND BLVD. STE 2 STATEN ISLAND, NY 10306 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $16K | — | $16K | 5.23% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INSURANCE SRVS. | 800 MAIN STREET DUBUQUE, IA 520040028 | DELTA DENTAL OF NEW JERSEY, INC. | $12K | — | $12K | 4.37% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SVCS | 800 MAIN ST DUBUQUE, IA 52001 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17K | $3K | $20K | 8.34% |
| DANIEL FROST3 | 241 POYGAN RD OMRO, WI 54963 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10K | $1K | $11K | 4.64% |
| CAMERON SUTTON ROBERTS3 | N9404 ROSELLA DRIVE APPLETON, WI 54914 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10K | $1K | $11K | 4.41% |
| MIH BENEFITS LLC3 | 106 CUMBERLYNN DR FOND DU LAC, WI 54935 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $210 | $3K | 1.34% |
| ADAM J ZAHN3 | 725 E GRANT STREET APPLETON, WI 54911 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $297 | $26 | $323 | 0.14% |
| RODNEY JAMES SONNENBERG3 | 432 AMORY ST FOND DU LAC, WI 54935 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $224 | $0 | $224 | 0.09% |
| HELEN DIZ-HATTON3 | 4 PALMER LN ENGLISHTOWN, NJ 07726 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $82 | $0 | $82 | 0.03% |
| REECE SUTTON ROBERTS3 | 1731 W WASHINGTON ST SUITE D APPLETON, WI 54914 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.00% |
| DON GORDON CRONIN3 | 960 JOHN NOLEN DR MADISON, WI 53713 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.00% |
| COTTINGHAM & BUTLER3 | 800 MAIN ST DUBUQUE, IA 52004 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | 7.11% |
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 | 346 | 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) | 358 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 636 | $5.8M |
| Dental | DELTA DENTAL OF NEW JERSEY, INC. | 623 | $280K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 871 | $63K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 344 | $545K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 344 | $306K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 344 | $306K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 344 | $545K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 871 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.