| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KLEIST, TRACY3 | 800 MAIN STREET PO BOX 28 DUBUQUE, IA 52004 | HEALTHPARTNERS INSURANCE COMPANY | $2K | — | $2K | 0.23% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INSURANCE | 2601 CROSSROADS DR STE 130 MADISON, WA 53718 | HUMANA INSURANCE COMPANY | $544 | — | $544 | 0.76% |
| J A COUNTER & ASSOCIATES INC3 Filed as: JA COUNTER & ASSOCIATES INC | PO BOX 387 NEW RICHMOND, WI 54017 | HUMANA INSURANCE COMPANY | $151 | — | $151 | 0.21% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SVCS INC | PO BOX 28 DUBUQUE, IA 52004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $3K | $11K | 17.32% |
| J A COUNTER & ASSOCIATES INC3 Filed as: JA COUNTER AND ASSOCIATES INC. | 1477 S KNOWLES AVE STE 200 NEW RICHMOND, WI 54017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 3.07% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SVCS INC | PO BOX 28 DUBUQUE, IA 52004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 6.70% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SVCS INC | PO BOX 28 DUBUQUE, IA 52004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $3K | $9K | 17.58% |
| J A COUNTER & ASSOCIATES INC3 Filed as: JA COUNTER AND ASSOCIATES INC | 1477 S KNOWLES AVE STE 200 NEW RICHMOND, WI 54017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 3.05% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SVCS INC | PO BOX 28 DUBUQUE, IA 52004 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 6.43% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MEDICA EIN 41-1479417 CLAIMS PROCESSING | 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 | 231 | 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) | 231 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | MEDICA INSURANCE COMPANY | 400 | $2.3M |
| Dental(2 contracts, 2 carriers) | HEALTHPARTNERS INSURANCE COMPANY | 400 | $813K |
| Vision | HUMANA INSURANCE COMPANY | 176 | $71K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 244 | $37K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 208 | $50K |
| Other(4 contracts, 2 carriers) | HEALTHPARTNERS INSURANCE COMPANY | 400 | $891K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 400 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.