| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COTTINGHAM & BUTLER3 | PO BOX 28 DUBUQUE, IA 520040028 | QUARTZ HEALTH BENEFIT PLANS CORPORATION | $20K | — | $20K | 2.09% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER | 800 MAIN ST DUBUQUE, IA 52001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | $3K | $15K | 11.03% |
| COTTINGHAM & BUTLER3 | 300 SECURITY BUILDING DUBUQUE, IA 52001 | DELTA DENTAL OF WISCONSIN | $5K | — | $5K | 7.04% |
| COTTINGHAM & BUTLER3 | 300 SECURITY BUILDING DUBUQUE, IA 52001 | WYSSTA INSURANCE COMPANY INC | $640 | — | $640 | 8.00% |
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 | 108 | 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) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 172 | $960K |
| Dental | DELTA DENTAL OF WISCONSIN | 84 | $69K |
| Vision | WYSSTA INSURANCE COMPANY INC | 67 | $8K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 108 | $134K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 108 | $134K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 108 | $134K |
| Prescription drug | QUARTZ HEALTH BENEFIT PLANS CORPORATION | 172 | $960K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 108 | $134K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 172 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.