| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INS SVCS LLC | 800 MAIN STREET DUBUQUE, IA 52001 | BLUE CROSS OF CALIFORNIA | $66K | $0 | $66K | 3.93% |
| MJ INSURANCE3 | PO BOX 3430 CARMEL, IN 46082 | BLUE CROSS OF CALIFORNIA | $6K | $0 | $6K | 0.36% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INS SVCS LLC | PO BOX 28 DUBUQUE, IA 52001 | DELTA DENTAL OF CALIFORNIA | $9K | $0 | $9K | 7.91% |
| MJ INSURANCE3 | PO BOX 3430 CARMEL, IN 46082 | DELTA DENTAL OF CALIFORNIA | $2K | $0 | $2K | 1.61% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INS SVCS LLC | 800 MAIN STREET DUBUQUE, IA 52001 | DELTA DENTAL OF CALIFORNIA | $582 | $0 | $582 | 0.52% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INS SVCS LLC | PO BOX 28 DUBUQUE, IA 52001 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $782 | $5K | 7.54% |
| MJ INSURANCE3 | PO BOX 3430 CARMEL, IN 46082 | METROPOLITAN LIFE INSURANCE COMPANY | $424 | $35 | $459 | 0.64% |
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 | 186 | 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) | 186 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 192 | $1.7M |
| Dental | DELTA DENTAL OF CALIFORNIA | 244 | $112K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 438 | $72K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 438 | $72K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 438 | $72K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 438 | $72K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 192 | $1.7M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 438 | $1.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 438 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.