| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THOMAS FULLER3 | 1830 BRENT BLVD. LINCOLN, NE 68506 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | $322 | $5K | 5.57% |
| SECURITY FIRST BANK3 | PO BOX 3490 RAPID CITY, SD 57709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 4.13% |
| ROBERT E ELLIS3 Filed as: ROBERT ELLIS | 11261 WRIGHT CIR. OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $219 | $2K | 1.81% |
| KRISTI LYN HOVIE3 Filed as: KRISTI HOVIE | 11261 WRIGHT CIR. OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $268 | $1K | 1.45% |
| THOMAS A HOUSE3 Filed as: THOMAS HOUSE | 2145 MAPLE ST. SIDNEY, NE 69162 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $31 | $1K | 1.19% |
| THOMAS JAMES BUTLER3 Filed as: THOMAS BUTLER | 7913 N 164TH ST. BENNINGTON, NE 68007 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $433 | $42 | $475 | 0.54% |
| KIMBERLY LEWIS3 | 13911 JOSEPHINE ST. OMAHA, NE 68138 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $389 | $5 | $394 | 0.45% |
| JULIE C SHARP3 Filed as: JULIE SHARP | 5810 NORTH 166TH ST. OMAHA, NE 68116 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $82 | — | $82 | 0.09% |
| CRISS BUTLER3 | 4924 EASTRIDGE DR. OMAHA, NE 68134 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $53 | $23 | $76 | 0.09% |
| STEPHANIE BRANCH3 | 11307 LAFAYETTE CT. OMAHA, NE 68154 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.03% |
| PERFORMAX INC3 Filed as: PERFORMAX INC. | 7004 SECURITY BLVD., STE. 300 BALTIMORE, MD 21244 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 8.76% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $573 | $4K | 5.02% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $6K | $11K | 13.52% |
| SECURITY INSURANCE AGENCY INC3 Filed as: SECURITY INSURANCE AGENCY | PO BOX 137 SIDNEY, NE 691620137 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 5.69% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 2.49% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | VISION SERVICE PLAN | $1K | — | $1K | 4.99% |
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 | 233 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 234 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 164 | $79K |
| Vision | VISION SERVICE PLAN | 170 | $25K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 220 | $80K |
| Short-term disability | STANDARD INSURANCE COMPANY | 233 | $71K |
| Long-term disability | STANDARD INSURANCE COMPANY | 233 | $71K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 220 | $168K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 233 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.