| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SERVICES | PO BOX 28 DUBUQUE, IA 520040028 | VISION SERVICE PLAN | — | $1K | $1K | 5.50% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SERVICES | PO BOX 28 DUBUQUE, IA 520040028 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | $228 | $1K | 13.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHY ALLIANCE LIFE INSURANCE EIN 86-0257201 PROVIDER | Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | 100 MADISON STREET STE 800 SYRACUSE, NY 13202 | $161K |
| COTTINGHAM AND BUTLER INSURANCE EIN 42-0198040 PROVIDER | Other commissions; Insurance brokerage commissions and fees; Other fees; Other services; Insurance agents and brokers Service code 22 | 800 MAIN STREET DUBUQUE, IA 52001 | $0 |
| INGENIORX, INC. EIN 82-3062245 PROVIDER | Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | 450 HEADQUARTERS PLAZA, 7TH FLOOR MORRISTOWN, NJ 07960 | $0 |
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 | 117 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTHY ALLIANCE LIFE INSURANCE COMPANY | 106 | $862K |
| Dental | HEALTHY ALLIANCE LIFE INSURANCE COMPANY | 106 | $862K |
| Vision | VISION SERVICE PLAN | 103 | $20K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 394 | $10K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 394 | $10K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 394 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 394 | — |
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.