| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | P.O. BOX 843844 KANSAS CITY, MO 64184 | HARTFORD LIFE AND ACCIDENT | $23K | $4K | $27K | 5.81% |
| LOCKTON COMPANIES, LLC3 | P.O. BOX 843844 KANSAS CITY, MO 64184 | VISION SERVICE PLAN | $2K | — | $2K | 3.96% |
| MICHAEL DONLEY3 Filed as: MICHAEL N SUNDERMAN | 2912 HAMILTON BOULEVARD, SUITE 104 SIOUX CITY, IA 51104 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $862 | — | $862 | 5.88% |
| JAMES A SMAARDYK3 | 2831 CEDAR HILLS LANE TWIN LAKE, MI 49457 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $520 | — | $520 | 3.55% |
| JEFFREY W WOOLDRIDGE3 | 14 N HIDDEN ACRES DRIVE SIOUX CITY, IA 51108 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $120 | — | $120 | 0.82% |
| THOMAS W BOSTON3 | 1275 WEST MAPLE STREET HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $37 | — | $37 | 0.25% |
| MICHAEL DONLEY3 Filed as: MICHAEL N SUNDERMAN | 2912 HAMILTON BOULEVARD, SUITE 104 SIOUX CITY, IA 51104 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $658 | — | $658 | 5.87% |
| JEFFREY W WOOLDRIDGE3 | 14 N HIDDEN ACRES DRIVE SIOUX CITY, IA 51108 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $221 | — | $221 | 1.97% |
| JAMES A SMAARDYK3 | 2831 CEDAR HILLS LANE TWIN LAKE, MI 49457 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $132 | — | $132 | 1.18% |
| THOMAS W BOSTON3 | 1275 WEST MAPLE STREET HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $8 | — | $8 | 0.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WELLMARK BLUE CROSS AND BLUE SHIELD EIN 42-0318333 ADMINISTRATOR | Contract Administrator Service code 13 | — | $175K |
| LOCKTON COMPANIES, LLC BROKER | Insurance agents and brokers Service code 22 | 444 WEST 47TH STREET KANSAS CITY, MO 64112 | $81K |
| DELTA DENTAL OF IOWA EIN 42-0959302 ADMINISTRATOR | Contract Administrator Service code 13 | — | $18K |
| TRISTAR BENEFIT ADMINISTRATORS EIN 22-1962146 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $5K |
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 | 313 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 35 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 348 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 201 | $43K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 313 | $460K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 313 | $460K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 313 | $460K |
| Other(3 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 313 | $486K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 313 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.