| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OLSON, TIMOTHY H3 | 16820 FRANCES STREET SUITE 101 OMAHA, NE 68130 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $40K | — | $40K | 7.26% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH DBA TIM OLSON INC | 16820 FRANCES STREET SUITE 202 OMAHA, NE 68130 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $7K | $7K | 1.23% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: SILVERSTONE GROUP INCORPORATED | 11516 MIRACLE HILLS DRIVE SUITE 100 OMAHA, NE 68154 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $237 | $1K | 0.24% |
| OLSON, TIMOTHY H3 | 16820 FRANCES STREET SUITE 101 OMAHA, NE 68130 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $21K | — | $21K | 15.00% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH DBA TIM OLSON INC | 16820 FRANCES STREET SUITE 202 OMAHA, NE 68130 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 1.25% |
| TIM OLSON INC3 | 16820 FRANCES STREET SUITE 202 OMAHA, NE 68130 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $9K | — | $9K | 16.40% |
| SUPPLEMENTAL INSURANCE PROFESSIONAL3 Filed as: SUPPLEMENTAL INS PROF LLC | 1956 PARK AVENUE DES MOINES, IA 50315 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $2K | — | $2K | 2.85% |
| ALAN PAPE3 | 115 EAST PLATT STREET MAQUOKETA, IA 52060 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $16 | — | $16 | 0.03% |
| OLSON, TIMOTHY H3 | 16820 FRANCES STREET SUITE 101 OMAHA, NE 68130 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 7.51% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH DBA TIM OLSON INC | 16820 FRANCES STREET SUITE 202 OMAHA, NE 68130 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $481 | $481 | 1.25% |
| TIM OLSON INC3 | 16820 FRANCES STREET SUITE 202 OMAHA, NE 68130 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $5K | — | $5K | 14.69% |
| SUPPLEMENTAL INSURANCE PROFESSIONAL3 Filed as: SUPPLEMENTAL INS PROF LLC | 1956 PARK AVENUE DES MOINES, IA 50315 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $943 | — | $943 | 2.57% |
| TIM OLSON INC3 Filed as: TIM OLSON INC. | — | SCRIPTSOURCING, LLC | $7K | — | $7K | — |
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 | 501 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 501 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 501 | $180K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,197 | $557K |
| Prescription drug | SCRIPTSOURCING, LLC | 22 | $0 |
| Stop-loss / reinsurancereinsurance | IRONSHORE INDEMNITY, INC. | 458 | $564K |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 501 | $272K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,197 | — |
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.