| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR UBANDALE, IA 50323 | PRINCIPAL LIFE INSURANCE COMPANY | $87K | $12K | $99K | 14.71% |
| ACRISURE LLC3 | 2625 W PETERSON AVE CHICAGO, IL 60659 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $6K | $6K | 0.89% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12K | $0 | $12K | 4.99% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT E ELLIS | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9K | $1K | $10K | 4.18% |
| DALE I DAVIS3 Filed as: DALE JOHNSTON | 1612 M AVE MILFORD, IA 51351 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 1.26% |
| FIRST AMERICAN INSURANCE3 | 2621 W US HWY 30 GRAND ISLAND, NE 68803 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 0.78% |
| RICHARD G MCGOWAN3 | 1716 N 59TH ST OMAHA, NE 68104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $46 | $2K | 0.77% |
| HOVIE AGENCY LLC3 | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $268 | $2K | 0.75% |
| KIMBERLY LEWIS3 | 13911 JOSEPHINE ST OMAHA, NE 68138 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $6 | $1K | 0.58% |
| NIKOLE R WULFF3 | PO BOX 3193 OMAHA, NE 68103 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 0.47% |
| MICHAEL DONLEY3 | 2241 PUEBLO COURT SIOUX CITY, IA 51104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $684 | $5 | $689 | 0.28% |
| JERRY A EDGAR3 | 604 SOUTH MARKET ST SHICKLEY, NE 68436 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $118 | $0 | $118 | 0.05% |
| JERRI J GREGORY3 | 791 NW 43RD AVE DES MOINES, IA 50313 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $101 | $0 | $101 | 0.04% |
| JASON DENNIS HOSEK3 | 1616 BRECA RIDGE DR ANAMOSA, IA 52205 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | $0 | $33 | 0.01% |
| MA STILES LLC3 | 12223 CUMING ST OMAHA, NE 68154 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | $0 | $13 | 0.01% |
| DEAM W FPRMAFF3 | 16041 BUFFALO RD SPRINGFIELD, NE 68059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | $0 | $9 | 0.00% |
| BRYON A BROWDER3 | 75 NW 57TH PL DES MOINES, IA 50313 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 0.00% |
| CYD M WYATT3 | 1011 N 49TH AVE OMAHA, NE 68132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 0.00% |
| BARBARA MARIE MCDONALD3 | 1630 TIMBER COURT SE CEDAR RAPIDS, IA 52403 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.00% |
| DUSTIN LEE CLAIR3 | 4814 M AVE NW CEDAR RAPIDS, IA 52405 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.00% |
| JOAN C MCGILL3 | 1721 N 127 STREET OMAHA, NE 68154 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.00% |
| TODD BURKE3 Filed as: TODD MICHAEL COHOE | 2835 S 1036TH ST OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | 11 SCOTT STREET WAUSA, WI 54403 | $260K |
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 | 583 | 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) | 583 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 741 | $675K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 741 | $675K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 413 | $245K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 741 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.