| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | P.O. BOX 843844 KANSAS CITY, MO 64184 | HARTFORD LIFE AND ACCIDENT | $16K | $5K | $21K | 6.50% |
| LOCKTON COMPANIES, LLC3 | P.O. BOX 843844 KANSAS CITY, MO 64184 | VISION SERVICE PLAN | $1K | — | $1K | 3.51% |
| MICHAEL DONLEY3 Filed as: MICHAEL N SUNDERMAN | 2912 HAMILTON BOULEVARD, SUITE 104 SIOUX CITY, IA 51104 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 5.65% |
| JAMES A SMAARDYK3 | 2831 CEDAR HILLS LANE TWIN LAKE, MI 49457 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $855 | — | $855 | 4.44% |
| JEFFREY W WOOLDRIDGE3 | 14 N HIDDEN ACRES DRIVE SIOUX CITY, IA 51108 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $130 | — | $130 | 0.67% |
| THOMAS W BOSTON3 | 1275 WEST MAPLE STREET HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $53 | — | $53 | 0.28% |
| MICHAEL DONLEY3 Filed as: MICHAEL N SUNDERMAN | 2912 HAMILTON BOULEVARD, SUITE 104 SIOUX CITY, IA 51104 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $699 | — | $699 | 5.56% |
| JEFFREY W WOOLDRIDGE3 | 14 N HIDDEN ACRES DRIVE SIOUX CITY, IA 51108 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $249 | — | $249 | 1.98% |
| JAMES A SMAARDYK3 | 2831 CEDAR HILLS LANE TWIN LAKE, MI 49457 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $125 | — | $125 | 0.99% |
| THOMAS W BOSTON3 | 1275 WEST MAPLE STREET HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $7 | — | $7 | 0.06% |
| AON CONSULTING INC3 Filed as: AON CONSULTING | P.O. BOX 905494, SUITE 400 CHARLOTTE, NC 28290 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $444 | — | $444 | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF IOWA EIN 42-0959302 ADMINISTRATOR | Contract Administrator Service code 13 | — | $16K |
| TRISTAR BENEFIT ADMINISTRATORS EIN 22-1962146 ADMINISTRATOR | Claims processing Service code 12 | — | $7K |
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 | 301 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 46 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 347 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 25 | $32K |
| Vision | VISION SERVICE PLAN | 176 | $40K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 348 | $327K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 348 | $327K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 348 | $327K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 348 | $329K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 348 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.