| 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 | $49K | — | $49K | 1.08% |
| ARTHUR VANDER WILT3 | PO BOX 248 SHELDON, IA 51201 | AFLAC | $5K | $85 | $5K | 6.11% |
| STEVE VONK3 | 1602 10TH ST ROCK VALLEY, IA 51247 | AFLAC | $2K | — | $2K | 2.71% |
| MARK FRIEHE3 Filed as: MARK E FRIEHE | 4611 S 96TH ST STE 101 OMAHA, NE 68127 | AFLAC | $751 | — | $751 | 0.96% |
| JANE POTTEBAUM3 | 19258 HAWTHORNE AVE CARROLL, IA 51401 | AFLAC | $298 | — | $298 | 0.38% |
| VARIOUS3 | — | AFLAC | $174 | $26 | $200 | 0.25% |
| ANDREW E HEYING3 | 205 CLINTON AVE ALTON, IA 51003 | AFLAC | $75 | — | $75 | 0.10% |
| VAN ENGELENHOVEN AGENCY INC3 | 122 CENTRAL AVE SW ORANGE CITY, IA 51041 | AFLAC | $71 | — | $71 | 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% |
| VAN ENGELENHOVEN AGENCY INC4 | 122 CENTRAL AVE SW ORANGE CITY, IA 51041 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $776 | — | $776 | 7.59% |
| VONK INSURANCE AGENCY4 | 1602 10TH ST ROCK VALLEY, IA 51247 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $130 | — | $130 | 1.27% |
| 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 | $192K |
| PARTNERS HEALTH INSURANCE INC BROKER | Consulting (general) Service code 16 | 122 CENTRAL AVE SW ORANGE CITY, IA 51041 | $49K |
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 | 483 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 483 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA | 259 | $4.6M |
| Dental | WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA | 253 | $171K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 483 | $48K |
| Life insurance | EMC NATIONAL LIFE COMPANY | 290 | $72K |
| Other(2 contracts, 2 carriers) | AFLAC | 100 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 483 | — |
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.