| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | TWO PIERCE PLACE ITASCA, IL 601433141 | WELLMARK BLUE CROSS AND BLUE SHIELD | $21K | — | $21K | 1.58% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 601433141 | WELLMARK BLUE CROSS BLUE SHIELD OF IOWA | $6K | — | $6K | 6.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 4280 SERGEANT ROAD SUITE 200 SIOUX CITY, IA 511064647 | UNION SECURITY INSURANCE COMPANY | $9K | $10 | $9K | 11.80% |
| MICHAEL DONLEY3 | 2241 PUEBLO COURT SIOUX CITY, IA 51104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $599 | $7K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | PO BOX 718 SIOUX CITY, IA 51102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $94 | $3K | 4.84% |
| KRISTI LYN HOVIE3 | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $451 | $2K | 2.65% |
| ROBERT ELLIS3 Filed as: ROBERT EUGENE ELLIS | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $365 | $2K | 2.59% |
| DUANE GOTTSCH3 | 2220 NORTH 172ND AVENUE OMAHA, NE 68116 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $887 | — | $887 | 1.33% |
| STEPHEN CORRIVEAU3 Filed as: STEPHEN J SALEM | 1506 COUNTRY CLUB DRIVE ELK POINT, SD 57025 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $415 | $227 | $642 | 0.96% |
| DALE I DAVIS3 Filed as: DALE JOHNSTON | 1612 M. AVENUE MILFORD, IA 51351 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $410 | $95 | $505 | 0.76% |
| PHIL HICKMAN3 | 3633 JONES STREET SIOUX CITY, IA 51104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $409 | — | $409 | 0.61% |
| RICHARD G MCGOWAN3 | 1716 N 59TH STREET OMAHA, NE 68104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $70 | — | $70 | 0.10% |
| JULIE C SHARP3 | 5810 NORTH 166TH STREET OMAHA, NE 68116 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $54 | — | $54 | 0.08% |
| DEAN W FORNOFF3 Filed as: DEAN FORNOFF | 16041 BUFFALO ROAD SPRINGFIELD, NE 68059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | — | $33 | 0.05% |
| MICHELLE MARIE GOERGEN3 | 5340 SOUTH 156 COURT OMAHA, NE 68135 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 0.04% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY INC | 500 WEST 13TH STREET FORT WORTH, TX 76102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | — | $23 | 0.03% |
| MATTHEW J CLAUSEN3 | 23088 JADE AVENUE MERRILL, IA 51038 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | — | $23 | 0.03% |
| SUSAN SIDELL3 | 931 W 42ND STREET HOUSTON, TX 77018 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| SCOTT SWARTZENDRUBER3 | 5701 KENTUCKY AVENUE NORTH CRYSTAL, MN 55428 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| CRISS BUTLER3 | 4924 EASTRIDGE DRIVE OMAHA, NE 68134 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.00% |
| DARIN POTTS3 | 510 BERING DRIVE HOUSTON, TX 77057 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.00% |
| SELECT NETWORKS3 | 317 6TH AVENUE DES MOINES, IA 50309 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 11.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 4280 SERGEANT ROAD SIOUX CITY, IA 51106 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
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 | 168 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 24 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 194 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | WELLMARK BLUE CROSS AND BLUE SHIELD | 139 | $1.4M |
| Dental | WELLMARK BLUE CROSS BLUE SHIELD OF IOWA | 147 | $98K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 243 | $20K |
| Life insurance(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 198 | $146K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 95 | $67K |
| Long-term disability | UNION SECURITY INSURANCE COMPANY | 198 | $80K |
| Prescription drug | WELLMARK BLUE CROSS AND BLUE SHIELD | 139 | $1.4M |
| Other(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 198 | $146K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 243 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.