| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INNOVATIVE BNFT CONSULTANTS3 | 412 WATER STREET SIOUX CITY, IA 51103 | WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA | $40K | — | $40K | 2.18% |
| INNOVATIVE BNFT CONSULTANTS3 | 412 WATER STREET SIOUX CITY, IA 51103 | DELTA DENTAL OF SOUTH DAKOTA | $3K | — | $3K | 1.40% |
| INNOVATIVE BNFT CONSULTANTS3 | 412 WATER STREET SIOUX CITY, IA 51103 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $8K | — | $8K | 10.00% |
| MICHAEL DONLEY3 | 2241 PUEBLO COURT SIOUX CITY, IA 51104 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $312 | $4K | 9.22% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | P.O. BOX 718 SIOUX CITY, IA 51102 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $98 | $2K | 5.08% |
| ROBERT E ELLIS3 | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $614 | $247 | $861 | 2.25% |
| KRISTI LYN HOVIE3 | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $492 | $198 | $690 | 1.80% |
| MATTHES J CLAUSEN3 | 23088 JADE AVE MERRILL, IA 51038 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $582 | — | $582 | 1.52% |
| DUANE A ADAMS3 Filed as: DUANE L GOTTSCH | 2220 NORTH 172ND AVENUE OMAHA, NE 68116 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $74 | — | $74 | 0.19% |
| GARY L HOLTROP3 | P.O. BOX 218 IRETON, IA 51027 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $51 | — | $51 | 0.13% |
| STEPHEN CORRIVEAU3 Filed as: STEPHEN J SALEM | 1506 COUNTRY CLUB DR ELK POINT, SD 57025 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $46 | — | $46 | 0.12% |
| SCOTT SWARTZENDRUBER3 | 600 HWY 169 SOUTH MINNEAPOLIS, MN 55426 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.04% |
| RICHARD G MCGOWAN3 | 1716 N 59TH STREET OMAHA, NE 68104 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| DEAN W FORNOFF3 | 16041 BUFFALO ROAD SPRINGFIELD, NE 68059 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| INNOVATIVE BNFT CONSULTANTS3 | 1119 4TH STREET, STE 109 SIOUX CITY, IA 51101 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| SELECT NETWORKS3 | 317 6TH AVENUE DES MOINES, IA 50309 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 8.00% |
| INNOVATIVE BNFT CONSULTANTS3 | 412 WATER STREET SIOUX CITY, IA 51103 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $638 | $0 | $638 | 8.26% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UW MEDICAL CENTER | Direct payment from the plan Service code 50 | 1959 NE PACIFIC ST SEATTLE, WA 98195 | $124K |
| DUNES FAMILY PHARMACY | Direct payment from the plan Service code 50 | 101 TOWER RD STE 130 DAKOTA DUNES, SD 57049 | $80K |
| CVS CAREMARK | Direct payment from the plan Service code 50 | 11162 RENNER RD LENEXA, KS 66219 | $70K |
| SIOUXLAND SURGERY CENTER LTD | Direct payment from the plan Service code 50 | 600 N SIOUX POINT RD DAKOTA DUNES, SD 57049 | $69K |
| CVS CAREMARK 02921 | Direct payment from the plan Service code 50 | 105 MALL BLVD MONROEVILLE, PA 15146 | $67K |
| EMBASSY REHABAND CARE CENTER INC | Direct payment from the plan Service code 50 | 206 PORT NEAL RD SERGEANT BLUFF, IA 51054 | $59K |
| ST LUKES REGIONAL MEDICAL CENTER | Direct payment from the plan Service code 50 | 2720 STONE PARK BLVD SIOUX CITY, IA 51104 | $45K |
| KEYSTONE TREATMENT CENTER | Direct payment from the plan Service code 50 | 1010 E 2ND ST CANTON, SD 57013 | $38K |
| MERCY MEDICAL CENTER SIOUX CITY | Direct payment from the plan Service code 50 | 801 5TH ST PO BOX 3168 SIOUX CITY, IA 51104 | $29K |
| SHOPKO PHARMACY | Direct payment from the plan Service code 50 | 3025 HAMILTON BLVD SIOUX CITY, IA 51104 | $22K |
| MAYO CLINIC HOSPITAL ROCHESTE | Direct payment from the plan Service code 50 | 1216 2ND ST. SW ROCHESTER, MN 55902 | $22K |
| SEATTLE CANCER CARE ALLIANCE | Direct payment from the plan Service code 50 | 825 EASTLAKE AVE E SEATTLE, WA 98109 | $16K |
| JACKSON RECOVERY CENTERS INC | Direct payment from the plan Service code 50 | 800 5TH ST STE 200 SIOUX CITY, IA 51101 | $15K |
| MAYO CLINIC | Direct payment from the plan Service code 50 | 200 1ST ST SW ROCHESTER, MN 55905 | $15K |
| WALMART PHARMACY 101332 | Direct payment from the plan Service code 50 | 1601 CORNHUSKERS DR S SIOUX CITY, NE 68776 | $15K |
| ELIZABETH M AUGUSTINE HARTMAN MD EMPLOYER | Direct payment from the plan Service code 50 | 575 SIOUX POINT RD DAKOTA DUNES, SD 57049 | $14K |
| INDERJIT S CHABRA MD | Direct payment from the plan Service code 50 | 705 SIOUX POINT RD STE 100 DAKOTA DUNES, SD 57049 | $14K |
| SANFORD USD MEDICAL CENTER | Direct payment from the plan Service code 50 | 1305 W 18TH ST SIOUX FALLS, SD 57105 | $14K |
| FAMILY HEALTH CARE OF SIOUXLAND | Direct payment from the plan Service code 50 | 814 PIERCE ST STE 300 SIOUX CITY, IA 51101 | $13K |
| PIERCE STREET SAME DAY SURGERY LC | Direct payment from the plan Service code 50 | 2730 PIERCE ST STE 100 SIOUX CITY, IA 51104 | $12K |
| CHILDRENS HOSPITAL AND MEDIC | Direct payment from the plan Service code 50 | PO BOX 247036 OMAHA, NE 68124 | $12K |
| WALGREENS 15647 | Direct payment from the plan Service code 50 | 1900 HAMILTON BLVD SIOUX CITY, IA 51104 | $11K |
| STEVEN J FERGUSON OD | Direct payment from the plan Service code 50 | 305 DAKOTA DUNES BLVD DAKOTA DUNES, SD 57049 | $11K |
| JON M GRUDEM MD EMPLOYER | Direct payment from the plan Service code 50 | 575 SIOUX POINT RD DAKOTA DUNES, SD 57049 | $10K |
| LEEDS PHARMACY INC | Direct payment from the plan Service code 50 | 2729 OUTER DRIVE SIOUX CITY, IA 51104 | $9K |
| HY VEE PHARMACY 1610 | Direct payment from the plan Service code 50 | 313 COOK ST SIOUX CITY, IA 51103 | $9K |
| DOUGLAS J BLOCK PA EMPLOYER | Direct payment from the plan Service code 50 | 575 SIOUX POINT RD DAKOTA DUNES, SD 57049 | $9K |
| TAUHNI T HUNT MD | Direct payment from the plan Service code 50 | 2730 PIERCE ST STE 201 SIOUX CITY, IA 51104 | $9K |
| CAROL A DONAHUE DPM EMPLOYER | Direct payment from the plan Service code 50 | 575 SIOUX POINT RD DAKOTA DUNES, SD 57049 | $8K |
| LISA A REMER GILLETT MD | Direct payment from the plan Service code 50 | 345 W STEAMBOAT DR STE 300 DAKOTA DUNES, SD 57049 | $8K |
| MARY T SCHNEIDER MD | Direct payment from the plan Service code 50 | 1000 JACKSON ST SIOUX CITY, IA 51105 | $8K |
| ADNAN A QALBANI MD | Direct payment from the plan Service code 50 | 330 DAKOTA DUNES BLVD 200 DAKOTA DUNES, SD 57049 | $8K |
| THOMPSON DEAN DRUG | Direct payment from the plan Service code 50 | 911 W 7TH ST SIOUX CITY, IA 51103 | $8K |
| AMANDA R DANNENBRING DO | Direct payment from the plan Service code 50 | 345 W STEAMBOAT DR STE 300 DAKOTA DUNES, SD 57049 | $8K |
| WADE K JENSEN MD EMPLOYER | Direct payment from the plan Service code 50 | 575 SIOUX POINT RD DAKOTA DUNES, SD 57049 | $7K |
| HY VEE PHARMACY 1614 | Direct payment from the plan Service code 50 | 4500 SERGEANT RD SIOUX CITY, IA 51106 | $7K |
| MINHTRIET H LUU MD | Direct payment from the plan Service code 50 | 330 DAKOTA DUNES BLVD 200 DAKOTA DUNES, SD 57049 | $7K |
| ANN E REHAN MD | Direct payment from the plan Service code 50 | 1125 PIERCE ST SIOUX CITY, IA 51105 | $7K |
| MIDWEST SURGICAL HOSPITAL LLC | Direct payment from the plan Service code 50 | 6128 S LYNCREST AVE SIOUX FALLS, SD 57108 | $7K |
| PROVIDENCE INFUSION AND PHARM | Direct payment from the plan Service code 50 | 3333 S 120TH PL TUKWILA, WA 98168 | $6K |
| BRIAN D JOHNSON MD EMPLOYER | Direct payment from the plan Service code 50 | 575 SIOUX POINT RD DAKOTA DUNES, SD 57049 | $6K |
| DANIELLE J HAY DO | Direct payment from the plan Service code 50 | 1000 JACKSON ST SIOUX CITY, IA 51105 | $6K |
| THORSON DRUG | Direct payment from the plan Service code 50 | 233 REED ST AKRON, IA 51001 | $6K |
| ALLISON S SCHOENFELDER MD | Direct payment from the plan Service code 50 | 321 MILL ST AKRON, IA 51001 | $6K |
| JOEY L SCHROEDER DC | Direct payment from the plan Service code 50 | 711 SIOUX POINT RD STE 300 DAKOTA DUNES, SD 57049 | $6K |
| EMBASSY HEALTHCARE COMMUNITY | Direct payment from the plan Service code 50 | 206 PORT NEAL RD SERGEANT BLUFF, IA 51054 | $6K |
| SIOUXLAND UROLOGY CENTER LLC | Direct payment from the plan Service code 50 | 455 SIOUX POINT RD DAKOTA DUNES, SD 57049 | $5K |
| KEVIN W HAMBURGER MD | Direct payment from the plan Service code 50 | 1000 JACKSON ST SIOUX CITY, IA 51105 | $5K |
| RYAN M DUHAIME PT EMPLOYER | Direct payment from the plan Service code 50 | 575 SIOUX POINT RD DAKOTA DUNES, SD 57049 | $5K |
| ANGELA J ALDRICH MD | Direct payment from the plan Service code 50 | 2730 PIERCE ST STE 201 SIOUX CITY, IA 51104 | $5K |
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 | 211 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 211 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 46 | $38K |
| Dental | DELTA DENTAL OF SOUTH DAKOTA | 496 | $194K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 295 | $27K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 211 | $46K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 46 | $38K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 204 | $83K |
| Stop-loss / reinsurancereinsurance | WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA | 168 | $1.8M |
| Other(2 contracts, 2 carriers) | WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA | 211 | $1.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 496 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.