| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ZACH CORPORATION3 Filed as: ZACH CORPORATION DBA GROUP BEN | 622 PROGRESS AVE PO BOX 2597 WATERLOO, IA 50701 | WELLMARK BLUE CROSS AND BLUE SHIELD OF IOWA | $13K | — | $13K | 0.73% |
| PEDERSEN DOWIE CLABBY3 | 3022 AIRPORT BLVD PO BOX 2597 WATERLOO, IA 50701 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | — | $4K | 2.85% |
| PEDERSEN DOWIE CLABBY3 | 3022 AIRPORT BLVD PO BOX 2597 WATERLOO, IA 50703 | METROPOLITAN LIFE INSURANCE COMPANY | $7K | — | $7K | 8.91% |
| CYPRESS BENEFIT ADMINISTRATORS, LLC3 Filed as: CYPRESS BENEFIT ADMINISTRATORS LLC | 5560 W. GRANDE MARKET DRIVE APPLETON, WI 54913 | PARETO UNDERWRITE GREENWICH | — | $30K | $30K | 39.85% |
| HSTECHNOLOGY SOLUTIONS, INC3 Filed as: HSTECHNOLOGY SOLUTIONS | 3857 BIRCH STREET SUITE 586 NEWPORT BEACH, CA 92660 | PARETO UNDERWRITE GREENWICH | — | $13K | $13K | 17.45% |
| PHCS3 Filed as: HEALTHEOS BY MULTIPLAN INC. | PO BOX 29380 NEW YORK, NY 10087 | PARETO UNDERWRITE GREENWICH | — | $6K | $6K | 7.48% |
| MEDWATCH LLC3 Filed as: MEDWATCH | PO BOX 21796 TAMPA, FL 33630 | PARETO UNDERWRITE GREENWICH | — | $5K | $5K | 7.08% |
| PDCM INSURANCE3 | 3022 AIRPORT BLVD WATERLOO, IA 50703 | PARETO UNDERWRITE GREENWICH | — | $5K | $5K | 6.39% |
| AMERICAN HEALTH HOLDING3 Filed as: AMERICAN HEALTH HOLDING CONSULT DOC | PO BOX 360142 PITTSBURGH, PA 15250 | PARETO UNDERWRITE GREENWICH | — | $3K | $3K | 4.00% |
| TRUE NETWORK ADVISORS3 | 1513 AMBER LANE GUNTERSVILLE, AL 35976 | PARETO UNDERWRITE GREENWICH | — | $749 | $749 | 1.00% |
| PEDERSEN DOWIE CLABBY3 | 3022 AIRPORT BLVD PO BOX 2597 WATERLOO, IA 50701 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | — | $4K | 9.82% |
| PEDERSEN DOWIE CLABBY3 | 3022 AIRPORT BLVD PO BOX 2597 WATERLOO, IA 50701 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 12.31% |
| PEDERSEN DOWIE CLABBY3 | 3022 AIRPORT BLVD PO BOX 2597 WATERLOO, IA 50701 | METROPOLITAN LIFE INSURANCE COMPANY | $820 | — | $820 | 6.12% |
| CYPRESS BENEFIT ADMINISTRATORS, LLC Filed as: CYPRESS BENEFIT ADMINISTRATORS LLC | 5560 W GRANDE MARKET DR APPLETON, WI 54913 | CYPRESS BENEFIT ADMINISTRATORS | — | $3K | $3K | 100.00% |
| PEDERSEN DOWIE CLABBY3 | 3022 AIRPORT BLVD PO BOX 2597 WATERLOO, IA 50701 | METROPOLITAN LIFE INSURANCE COMPANY | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 INSURANCE PROVIDER | Insurance services Service code 23 | 501 US HIGHWAY 22 2ND FLOOR - WEST BRIDGEWATER, NJ 08807 | $316K |
| WELLMARK BLUE CROSS BLUE SHEILD IA EIN 42-0318333 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $133K |
| CYPRESS BENEFIT ADMINISTRATORS, LLC EIN 39-1997579 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | 5560 W. GRANDE MARKET DRIVE APPLETON, WI 54913 | $30K |
| HSTECHNOLOGY SOLUTIONS EIN 27-1818792 SERVICE PROVIDER | Other fees Service code 99 | 3857 BIRCH STREET SUITE 586 NEWPORT BEACH, CA 92660 | $13K |
| HEALTHEOS BY MULTIPLAN, INC EIN 39-1634080 SERVICE PROVIDER | Other fees Service code 99 | PO BOX 29380 NEW YORK, NY 10087 | $6K |
| MEDWATCH EIN 16-1662117 SERVICE PROVIDER | Other fees Service code 99 | PO BOX 21796 TAMPA, FL 33630 | $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 | 790 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 790 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | WELLMARK BLUE CROSS AND BLUE SHIELD OF IOWA | 418 | $1.9M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 453 | $149K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 392 | $44K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 997 | $82K |
| Short-term disability(2 contracts, 2 carriers) | CYPRESS BENEFIT ADMINISTRATORS | 441 | $3K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 186 | $27K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 997 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 997 | — |
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.