| 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 | -$117 | — | -$117 | -0.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 601433141 | WELLMARK BLUE CROSS BLUE SHIELD OF IOWA | $7K | — | $7K | 5.85% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 4280 SERGEANT ROAD SUITE 200 SIOUX CITY, IA 511064647 | UNION SECURITY INSURANCE COMPANY | $10K | — | $10K | 10.33% |
| MICHAEL DONLEY3 | 2241 PUEBLO COURT SIOUX CITY, IA 51104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | $116 | $6K | 7.46% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | PO BOX 718 SIOUX CITY, IA 51102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $111 | $4K | 4.86% |
| KRISTI LYN HOVIE3 | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $368 | $2K | 2.14% |
| ROBERT ELLIS3 Filed as: ROBERT EUGENE ELLIS | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $303 | $2K | 2.13% |
| DALE I DAVIS3 Filed as: DALE JOHNSTON | 1612 M. AVENUE MILFORD, IA 51351 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $511 | $156 | $667 | 0.89% |
| DEAN W FORNOFF3 Filed as: DEAN FORNOFF | 16041 BUFFALO ROAD SPRINGFIELD, NE 68059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $617 | $31 | $648 | 0.87% |
| DUANE A ADAMS3 Filed as: DUANE L GOTTSCH | 2220 NORTH 172ND AVENUE OMAHA, NE 68116 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $438 | — | $438 | 0.59% |
| DIANA Y MADEJ3 | 2923 LYNNWOOD DRIVE BELLEVUE, NE 68123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $43 | — | $43 | 0.06% |
| RICHARD G MCGOWAN3 | 1716 N 59TH STREET OMAHA, NE 68104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | — | $38 | 0.05% |
| USI INSURANCE SERVICES LLC3 | 15350 25TH AVENUE NORTH PLYMOUTH, MN 55447 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.03% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY INC | 500 WEST 13TH STREET FORT WORTH, TX 76102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.03% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.02% |
| CRISS BUTLER3 | 4924 EASTRIDGE DRIVE OMAHA, NE 68134 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.01% |
| JON SCOTT SWARTZENDRUBER3 | 600 HIGHWAY 169 SOUTH MINNEAPOLIS, MN 55426 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.00% |
| DARIN POTTS3 | 510 BERING DRIVE HOUSTON, TX 77057 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.00% |
| ELIZABETH MARIE LANGEVIN3 | 698 W LARPENTEUR AVE ST. PAUL, MN 55113 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.00% |
| SELECT NETWORKS3 | 317 6TH AVENUE, SUITE 1440 DES MOINES, IA 50309 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 11.02% |
| 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 | 10.01% |
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 | 167 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 172 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | WELLMARK BLUE CROSS AND BLUE SHIELD | 163 | $1.6M |
| Dental | WELLMARK BLUE CROSS BLUE SHIELD OF IOWA | 172 | $118K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 250 | $20K |
| Life insurance(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 220 | $176K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 101 | $75K |
| Long-term disability | UNION SECURITY INSURANCE COMPANY | 220 | $101K |
| Prescription drug | WELLMARK BLUE CROSS AND BLUE SHIELD | 163 | $1.6M |
| Other(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 220 | $176K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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.