| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | 8420 W DODGE RD STE 510 OMAHA, NE 68114 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $55 | $6K | 7.00% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INS SERVICES INC | 5444 WESTHEIMER RD STE 900 HOUSTON, TX 77056 | METROPOLITAN LIFE INSURANCE COMPANY | — | $815 | $815 | 1.00% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 444 W 47TH ST STE 900 ATTN TELLYE HEDRICK KANSAS CITY, MO 641121906 | METROPOLITAN LIFE INSURANCE COMPANY | — | $74 | $74 | 0.09% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INS SERVICES | 5444 WESTHEIMER RD STE 900 HOUSTON, TX 770565306 | METROPOLITAN LIFE INSURANCE COMPANY | — | $10 | $10 | 0.01% |
| DEAN W FORNOFF3 | 16041 BUFFALO ROAD SPRINGFIELD, NE 68059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $975 | — | $975 | 4.80% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT E ELLIS | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $428 | $2 | $430 | 2.12% |
| HOVIE AGENCY LLC3 | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $155 | $1 | $156 | 0.77% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KLH INSURANCE INC | 6505 DEMPSEY AVE SW WAVERLY, MN 55390 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $52 | — | $52 | 0.26% |
| CAROLYN GROVER3 | 206 FOX CHAPEL DR IRMO, SC 29063 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.13% |
| MARY-JOYCE LICATA3 Filed as: MARY J YARNELL | 170 E HAMILTON LN BATTLE CREEK, MI 49015 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.10% |
| RICHARD G MCGOWAN3 | 1716 N 59TH STREET OMAHA, NE 68104 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | — | $20 | 0.10% |
| MICHAEL DONLEY3 | 6300 S MAPLE ROCK TRAIL SIOUX FALLS, SD 57108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.03% |
| JOSEPH MICHAEL EVANS3 | 13848 ROSEWOOD DRIVE CLIVE, IA 50325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| JERRI J GREGORY3 | 791 NW 43RD AVE DES MOINES, IA 50313 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| NEBRASKA METHODIST HEALTH SYSTEM5 | 8511 WEST DODGE ROAD OMAHA, NE 68114 | NEBRASKA METHODIST HEALTH SYSTEM D/B/A BESTCARE EAP | — | $3K | $3K | — |
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 | 99 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 99 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 117 | $20K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 149 | $81K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 149 | $81K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 149 | $102K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 17 | $20K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 149 | $81K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 149 | $81K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 149 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.