| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLMARK INC3 | ANCILLARY MARKETING DEPARTMENT PO BOX 10481 DES MOINES, IA 50306 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $0 | $55K | $55K | 18.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT LTD URBANDALE, IA 503232317 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $21K | — | $21K | 7.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMENT DR URBANDALE, IA 50323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16K | — | $16K | 7.28% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT E ELLIS | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10K | $2K | $12K | 5.46% |
| BRYON A BROWDER3 | 791 NW 43RD AVE DES MOINES, IA 50313 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $251 | $4K | 1.99% |
| DALE I DAVIS3 Filed as: DALE JOHNSTON | 1612 M AVE MILFORD, IA 51351 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $607 | $3K | 1.44% |
| FIRST AMERICAN INSURANCE3 | PO BOX GRAND ISLAND, NE 68802 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 1.32% |
| RICHARD G MCGOWAN3 | 1716 N 59TH ST OMAHA, NE 68104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $121 | $3K | 1.22% |
| KRISTI LYN HOVIE3 | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $596 | $2K | 1.03% |
| JERRI J GREGORY3 | 791 NW 43RD AVE DES MOINES, IA 50313 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $841 | $2K | 0.85% |
| JOSEPH P CALARCO3 Filed as: JOSEPH MICHAEL EVANS | 4721 BROOKVIEW DR WEST DES MOINES, IA 50265 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $403 | $780 | $1K | 0.53% |
| MICHAEL DONLEY3 | 2241 PUEBLO COURT SIOUX CITY, IA 51104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $664 | $24 | $688 | 0.31% |
| DAVID J MCCLELLAN3 Filed as: DAVID E WYATT | 1011 N 49TH AVE OMAHA, NE 68132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $152 | — | $152 | 0.07% |
| DUANE A ADAMS3 Filed as: DUANE L GOTTSCH | 2220 NORTH 172ND AVE OMAHA, NE 68116 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $112 | — | $112 | 0.05% |
| JULIA C SHARP3 | 5810 NORTH 166TH ST OMAHA, NE 68116 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $86 | — | $86 | 0.04% |
| DEAN W FORNOFF3 | 16041 BUFFALO RD SPRINGFIELD, NE 68059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $84 | — | $84 | 0.04% |
| MATTHES J CLAUSEN3 | 23088 JADE AVE MERRILL, IA 51038 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | — | $41 | 0.02% |
| MAMIE A STILES3 | 12223 CUMING ST OMAHA, NE 68154 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 0.01% |
| MARK METTILLE3 Filed as: MARK WILSON | 18907 D STREET OMAHA, NE 68130 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.01% |
| JOAN C MCGILL3 | 1721 N 127 ST OMAHA, NE 68154 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.00% |
| TODD BURKE3 Filed as: TODD MICHAEL COHOE | 60 N HALIFAX DR ORMOND BEACH, FL 32176 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $18K | — | $18K | 14.94% |
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 | 599 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 600 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 738 | $118K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 427 | $304K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 738 | $342K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 738 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.