| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INSURANCE | 800 MAIN STREET DUBUQUE, IA 52001 | DELTA DENTAL OF ILLINOIS | $5K | — | $5K | 6.74% |
| GROUP BENEFITS LTD3 | 100 SW WASHINGTON ST PEORIA, IL 616021318 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 10.41% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER | 800 MAIN STREET DUBUQUE, IA 52001 | QBE INSURANCE CORPORATION | $2K | — | $2K | 10.00% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INSURANCE | 800 MAIN ST DUBUQUE, IA 52001 | PROTEC INSURANCE COMPANY | $1K | — | $1K | 8.98% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER | 800 MAIN ST DUBUQUE, IA 52001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $436 | $2K | 19.02% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER | 800 MAIN STREET DUBUQUE, IA 52001 | UNUM INSURANCE COMPANY | $868 | $95 | $963 | 20.24% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER | 800 MAIN ST DUBUQUE, IA 52001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $449 | $90 | $539 | 12.01% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER | 800 MAIN ST DUBUQUE, IA 52001 | UNUM INSURANCE COMPANY | $423 | $64 | $487 | 20.39% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $88K |
| MEDONE, LC EIN 26-1769761 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $23K |
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 | 183 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 185 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF ILLINOIS | 153 | $75K |
| Vision | PROTEC INSURANCE COMPANY | 153 | $12K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 153 | $4K |
| Long-term disability | STANDARD INSURANCE COMPANY | 164 | $37K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 153 | $437K |
| Other(5 contracts, 3 carriers) | QBE INSURANCE CORPORATION | 160 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 164 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.