| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT E ELLIS | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8K | $1K | $10K | 4.18% |
| DALE I DAVIS3 Filed as: DALE JOHNSTON | 1612 M AVE MILFORD, IA 51351 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $1K | $5K | 2.17% |
| KRISTI LYN HOVIE3 Filed as: KRISTI L HOVIE | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $376 | $2K | 0.79% |
| JENNIFER L HAVLOVICK3 | 4920 PLEASANT ST WEST DES MOINES, IA 50266 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $89 | $1K | 0.52% |
| RICHARD G MCGOWAN3 | 1716 N 59TH ST OMAHA, NE 68104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $949 | $17 | $966 | 0.42% |
| ANNE ELIZABETH SORRENTINO3 | 15223 HARNEY CIR OMAHA, NE 68154 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $716 | $0 | $716 | 0.31% |
| JERRI J GREGORY3 | 791 NW 43RD AVE DES MOINES, IA 50313 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $237 | $70 | $307 | 0.13% |
| BRYON A BROWDER3 | 75 NW 57TH PL DES MOINES, IA 50313 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $254 | $0 | $254 | 0.11% |
| JOSEPH EVAN3 Filed as: JOSEPH M. EVANS | 4721 BROOKVIEW DR WEST DES MOINES, IA 50265 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $94 | $110 | $204 | 0.09% |
| MICHAEL DONLEY3 | 2241 PUEBLO COURT SIOUX CITY, IA 51104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $68 | $8 | $76 | 0.03% |
| DEAN W FORNOFF3 | 16041 BUFFALO RD SPRINGFIELD, NE 68059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $55 | $0 | $55 | 0.02% |
| MAMIE A STILES3 | 12223 CUMING ST OMAHA, NE 68154 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | $0 | $16 | 0.01% |
| CRISS BUTLER3 | 4924 EASTRIDGE DR OMAHA, NE 68134 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | $2 | $13 | 0.01% |
| CYD M WYATT3 | 1011 N 49TH AVE OMAHA, NE 68132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 0.00% |
| JOAN C MCGILL3 | 1721 N 127 ST OMAHA, NE 68154 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.00% |
| TODD COHOE3 Filed as: TODD M COHOE | 2835 S 1036TH ST OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | PRINCIPAL LIFE INSURANCE COMPANY | $22K | $0 | $22K | 15.00% |
| WELLMARK INC3 | ANCILLARY MARKETING DEPT PO BOX 10481 DES MOINES, IA 50306 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $0 | $23K | $23K | 18.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 503232317 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $9K | $0 | $9K | 7.00% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 1.52% |
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 | 609 | 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) | 609 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $108K |
| Short-term disability(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 524 | $277K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 391 | $228K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 524 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.