| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 10050 REGENCY CIRCLE OMAHA, NE 68114 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14K | $488 | $15K | 9.99% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT E ELLIS | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11K | $3K | $14K | 9.16% |
| KRISTI LYN HOVIE3 | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $936 | $4K | 2.54% |
| DAVID J MCCLELLAN3 Filed as: DAVID E WYATT | 1011 N 49TH AVE OMAHA, NE 68132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $586 | $4K | 2.40% |
| CRISS BUTLER3 | 4924 EASTRIDGE DR OMAHA, NE 68134 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $553 | $2K | 1.48% |
| RICHARD G MCGOWAN3 | 1716 N 59TH STREET OMAHA, NE 68104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $90 | $2K | 1.07% |
| MAMIE A STILES3 | 12223 CUMING ST OMAHA, NE 68154 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $947 | $86 | $1K | 0.69% |
| DALLAS C MORENO3 | 6135 RIDGE PLACE SAN ANTONIO, TX 78250 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $568 | $73 | $641 | 0.43% |
| MICHAEL DONLEY3 | 2241 PUEBLO COURT SIOUX CITY, IA 51104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $461 | $25 | $486 | 0.33% |
| BRYON A BROWDER3 | 791 NW 43RD AVE DES MOINES, IA 50313 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $448 | $28 | $476 | 0.32% |
| HORIZON BENEFITS LLC3 | 9385 MILLER LANE GARDEN RIDGE, TX 78266 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | $102 | $149 | 0.10% |
| JULIA C SHARP3 | 5810 NORTH 166TH ST OMAHA, NE 68116 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $144 | — | $144 | 0.10% |
| JOSEPH P CALARCO3 Filed as: JOSEPH MICHAEL EVANS | 4721 BROOKVIEW DRIVE WEST DES MOINES, IA 50265 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | $63 | $95 | 0.06% |
| SA GENERAL AGENCY INC3 | 9385 MILLER LANE GARDEN RIDGE, TX 78266 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | $62 | $94 | 0.06% |
| THOMAS JAMES BUTLER3 | 7913 N 164TH ST BENNINGTON, NE 68007 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $67 | $4 | $71 | 0.05% |
| BRYAN INGLIS3 Filed as: BRYAN JAMES INGLIS | 1901 POST OAK BLVD HOUSTON, TX 77056 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $62 | — | $62 | 0.04% |
| JERRI J GREGORY3 | 791 NW 43RD AVE DES MOINES, IA 50313 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | $28 | $60 | 0.04% |
| MICHAEL ANTHONY CHANDLER3 Filed as: MICHAEL A CHANDLER | 16927 UNION CAVERN SAN ANTONIO, TX 78247 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | $1 | $48 | 0.03% |
| LAURIE J BURNS3 | 303 PLYLER ROAD INDIAN TRAIL, NC 28079 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $44 | — | $44 | 0.03% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY INC | 500 W 13TH STREET FORT WORTH, TX 76102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.01% |
| BRIAN WHITE3 Filed as: BRIAN R MADTES | 1308 JAMES COOK WINDCREST, TX 78239 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.01% |
| ELIZABETH GRACE GLOVER3 | 10519 MERRITIME COURT SAN ANTONIO, TX 78217 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 262 | $149K |
| Life insurance | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 262 | $149K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 262 | $149K |
| Long-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 262 | $149K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 262 | $149K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 262 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.