| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INSURANCE | SERVICES 800 MAIN STREET DUBUQUE, IA 52001 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $84K | $6K | $90K | 2.59% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INSURANCE | PO BOX 28 DUBUQUE, IA 52004 | SYMETRA LIFE INSURANCE COMPANY | $33K | $5K | $38K | 12.51% |
| NATIONAL ENROLLMENT PARTNERS GENERA3 Filed as: NATIONAL ENROLLMENT PARTNERS G | 2000 CHAPEL VIEW BLVD STE 240 CRANSTON, RI 02920 | SYMETRA LIFE INSURANCE COMPANY | — | $7K | $7K | 2.19% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INSURANCE | PO BOX 28 DUBUQUE, IA 520040028 | SYMETRA LIFE INSURANCE COMPANY | $13K | $4K | $17K | 24.02% |
| NATIONAL ENROLLMENT PARTNERS GENERA3 Filed as: NATIONAL ENROLLMENT PARTNERS G | 2000 CHAPEL VIEW BLVD STE 240 CRANSTON, RI 02920 | SYMETRA LIFE INSURANCE COMPANY | — | $1K | $1K | 1.48% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INS SERVICES | 800 MAIN STREET DUBUQUE, IA 52001 | DEARBORN LIFE INSURANCE COMPANY | $3K | $5K | $9K | 26.06% |
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 | 236 | 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) | 236 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 467 | $3.5M |
| Dental | BLUE CROSS BLUE SHIELD OF ILLINOIS | 467 | $3.5M |
| Vision | DEARBORN LIFE INSURANCE COMPANY | 233 | $33K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 368 | $306K |
| Short-term disability | SYMETRA LIFE INSURANCE COMPANY | 368 | $306K |
| Long-term disability | SYMETRA LIFE INSURANCE COMPANY | 368 | $306K |
| Other(2 contracts) | SYMETRA LIFE INSURANCE COMPANY | 368 | $378K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 467 | — |
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.