| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 503232317 | PRINCIPAL LIFE INSURANCE COMPANY | $63K | $20K | $83K | 14.19% |
| ACRISURE LLC3 | 2625 W PETERSON AVE CHICAGO, IL 606594004 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $3K | $3K | 0.56% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DR URBANDALE, IA 50323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7K | $0 | $7K | 3.15% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT E ELLIS | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $576 | $7K | 3.00% |
| HOVIE AGENCY LLC3 | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $146 | $1K | 0.57% |
| FIRST AMERICAN INSURANCE3 | 2621 W US HWY 30 GRAND ISLAND, NE 68803 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 0.54% |
| RICHARD G MCGOWAN3 | 1716 N 59TH ST OMAHA, NE 68104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $9 | $1K | 0.48% |
| KIMBERLY LEWIS3 | 13911 JOSEPINE ST OMAHA, NE 68138 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $644 | $0 | $644 | 0.29% |
| DALE I DAVIS3 Filed as: DALE JOHNSTON | 1612 M AVE MILFORD, IA 51351 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $493 | $0 | $493 | 0.22% |
| MICHAEL DONLEY3 | 6300 S MAPLE ROCK TRAIL SIOUX FALLS, IA 57108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $374 | $0 | $374 | 0.17% |
| EDGHILL ENTERPRISES LLC3 | 7811 FRAMTON DR LINCOLN, NE 68516 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $265 | $18 | $283 | 0.13% |
| JASON DENNIS HOSEK3 | 606 BROADWAY ST SPRINGVILLE, IA 52336 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $243 | $0 | $243 | 0.11% |
| NIKOLE R WULFF3 | PL BOX 3193 OMAHA, NE 68103 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $238 | $0 | $238 | 0.11% |
| JERRY A EDGAR3 | 604 SOUTH MARKET ST SHICKLEY, NE 68436 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $101 | $0 | $101 | 0.04% |
| JERRI J GREGORY3 | 791 NW 43RD AVE DES MOINES, IA 50313 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $92 | $0 | $92 | 0.04% |
| DUSTIN LEE CLAIR3 | 4814 M AVE NW CEDAR RAPIDS, IA 52405 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | $4 | $24 | 0.01% |
| BARBARA MARIE MCDONALD3 | 1630 TIMBER COURT SE CEDAR RAPIDS, IA 52403 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | $2 | $22 | 0.01% |
| MA STILES LLC3 | 12223 CUMING ST OMAHA, NE 68154 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 0.00% |
| DEAN W FORNOFF3 | 16041 BUFFALO RD SPRING FIELD, NE 68059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | $0 | $6 | 0.00% |
| JOAN C MCGILL3 | 1721 N 127 ST OMAHA, NE 68154 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.00% |
| CYD M WYATT3 | 1011 N 49TH AVE OMAHA, NE 68132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 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 | $241K |
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 | 552 | 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) | 552 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 552 | $584K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 552 | $584K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 281 | $226K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 552 | — |
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.