| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BREACH, VA 23466 | BLUE CROSS AND BLUE SHIELD OF KANSAS | $13K | — | $13K | 1.84% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: HAYS COMPANIES, INC./BROWN & BROWN | 7570 W 21ST STREET 1038-A WICHITA, KS 67205 | BLUE CROSS AND BLUE SHIELD OF KANSAS | $13K | — | $13K | 1.78% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $14K | $24K | 12.16% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 1200 MAIN ST STE 2310 KANSAS CITY, MO 64105 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $20K | — | $20K | 10.09% |
| USI INSURANCE SERVICES LLC3 | 245 NORTH WACO, SUITE 412 WICHITA, KS 67202 | DELTA DENTAL OF KANSAS, INC. | $2K | — | $2K | 2.96% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC - WICHITA | 7570 W 21ST STREET SUITE 1038-A WICHITA, KS 67205 | DELTA DENTAL OF KANSAS, INC. | $2K | — | $2K | 2.81% |
| RHONDA S PAPE3 Filed as: RHONDA S. PAPE | 115 EAST PLATT STREET MAQUOKETA, IA 52060 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $932 | — | $932 | 5.77% |
| USI INSURANCE SERVICES LLC3 | 245 NORTH WACO, SUITE 402 WICHITA, KS 67202 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $499 | — | $499 | 3.09% |
| DON DOHERTY3 | 710 WEST 8TH STREET, SUITE 206 FORT SCOTT, KS 66701 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $262 | — | $262 | 1.62% |
| DANE PAPE3 | 115 EAST PLATT STREET MAQUOKETA, IA 52060 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $236 | — | $236 | 1.46% |
| COLE PAPE3 Filed as: COLE M. PAPE | 115 EAST PLATT STREET MAQUOKETA, IA 52060 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $188 | — | $188 | 1.16% |
| JEREMY BOWMAN3 Filed as: JEREMY LOYAL BOWMAN | 1110 BURKE STREET FORT SCOTT, KS 66701 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $92 | — | $92 | 0.57% |
| ROBERT FLEMING3 | 3880 DUE WEST ROAD NW B-2 MARIETTA, GA 33064 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $77 | — | $77 | 0.48% |
| JESSE A WING3 Filed as: JESSE A. WING | 115 EAST PLATT STREET MAQUOKETA, IA 52060 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $74 | — | $74 | 0.46% |
| ALAN PAPE3 | 115 E PLATT ST MAQUOKETA, IA 52060 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $51 | — | $51 | 0.32% |
| GARY MCINTOSH3 Filed as: GARY G MCINTOSH | PO BOX 631 IOLA, KS 66749 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $14 | — | $14 | 0.09% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | 245 N WACO SUITE 402 WICHITA, KS 67202 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 9.05% |
| RHONDA S PAPE3 Filed as: RHONDA PAPE | 115 E PLATT ST MAQUOKETA, IA 52060 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 7.40% |
| DANE PAPE3 | 115 E PLATT ST MAQUOKETA, IA 52060 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $466 | — | $466 | 3.16% |
| COLE PAPE3 | 115 E PLATT ST MAQUOKETA, IA 52060 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $450 | — | $450 | 3.06% |
| DON DOHERTY3 | 710 W 8TH ST SUITE 206 FORT SCOTT, KS 66701 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $56 | — | $56 | 0.38% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC | 80 S 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $51 | — | $51 | 0.35% |
| JEREMY BOWMAN3 Filed as: JEREMY L BOWMAN | 1110 BURKE ST FORT SCOTT, KS 66701 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $45 | — | $45 | 0.31% |
| ALAN PAPE3 | 115 E PLATT ST MAQUOKETA, IA 52060 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $45 | — | $45 | 0.31% |
| GARY MCINTOSH3 | PO BOX 631 IOLA, KS 66749 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3 | — | $3 | 0.02% |
| USI INSURANCE SERVICES LLC3 | 245 NORTH WACO, SUITE 412 WICHITA, KS 67202 | SURENCY LIFE AND HEALTH | $667 | — | $667 | 5.06% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC - WICHITA | 7570 W 21ST STREET SUITE 1038-A WICHITA, KS 67205 | SURENCY LIFE AND HEALTH | $632 | — | $632 | 4.79% |
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 | 241 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 243 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF ALABAMA | 182 | $1.9M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF ALABAMA | 182 | $1.2M |
| Vision(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF ALABAMA | 182 | $1.2M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 241 | $198K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 241 | $198K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 241 | $198K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF ALABAMA | 182 | $1.9M |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 241 | $229K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 241 | — |
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."
No prospect flags tripped on this filing.