| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PARTNERS HEALTH INSURANCE3 Filed as: PARTNERS HEALTH INS LLC | 122 CENTRAL AVE SW ORANGE CITY, IA 51041 | WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA | $51K | — | $51K | 1.12% |
| ARTHUR VANDER WILT3 | PO BOX 248 SHELDON, IA 51201 | AFLAC | $6K | $264 | $6K | 8.04% |
| STEVE VONK3 | 1602 10TH ST ROCK VALLEY, IA 51247 | AFLAC | $2K | — | $2K | 2.54% |
| VARIOUS3 | — | AFLAC | $2K | $101 | $2K | 2.32% |
| VAN ENGELENHOVEN AGENCY INC3 | 122 CENTRAL AVE SW ORANGE CITY, IA 51041 | AFLAC | $645 | — | $645 | 0.84% |
| JANE POTTEBAUM3 | 19258 HAWTHORNE AVE CARROLL, IA 51401 | AFLAC | $317 | — | $317 | 0.41% |
| ANDREW E HEYING3 | 205 CLINTON AVE ALTON, IA 51003 | AFLAC | $101 | — | $101 | 0.13% |
| MARK FRIEHE3 Filed as: MARK E FRIEHE | 4611 S 96TH ST STE 101 OMAHA, NE 68127 | AFLAC | $67 | — | $67 | 0.09% |
| VAN ENGELENHOVEN AGENCY INC3 | 122 CENTRAL AVE SW ORANGE CITY, IA 51041 | EMC NATIONAL LIFE COMPANY | $7K | — | $7K | 10.00% |
| SELECT NETWORKS4 | 317 6TH AVE STE 1440 DES MOINES, IA 50309 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $5K | — | $5K | 11.00% |
| VAN ENGELENHOVEN AGENCY INC3 | 122 CENTRAL AVE SW ORANGE CITY, IA 51041 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $5K | — | $5K | 10.00% |
| VONK INSURANCE AGENCY4 | 1602 10TH ST ROCK VALLEY, IA 51247 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $941 | — | $941 | 9.23% |
| VAN ENGELENHOVEN AGENCY INC4 | 122 CENTRAL AVE SW ORANGE CITY, IA 51041 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $727 | — | $727 | 7.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WELLMARK BLUE CROSS BLUE SHIELD EIN 42-1459204 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 1331 GRAND AVE DES MOINES, IA 50309 | $188K |
| PARTNERS HEALTH INSURANCE INC BROKER | Consulting (general) Service code 16 | 122 CENTRAL AVE SW ORANGE CITY, IA 51041 | $51K |
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 | 492 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 492 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA | 269 | $4.6M |
| Dental | WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA | 264 | $155K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 492 | $50K |
| Life insurance | EMC NATIONAL LIFE COMPANY | 288 | $70K |
| Other(2 contracts, 2 carriers) | AFLAC | 112 | $87K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 492 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.