| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PEDERSEN DOWIE CLABBY & MCCAUSLAND3 | 3022 AIRPORT BLVD WATERLOO, IA 50703 | BLUE CROSS AND BLUE SHIELD OF MINNESOTA | $27K | $0 | $27K | 1.80% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DR STE 215 WASHINGTON, PA 19034 | BLUE CROSS AND BLUE SHIELD OF MINNESOTA | $19K | $0 | $19K | 1.25% |
| PEDERSEN DOWIE CLABBY & MCCAUSLAND3 | PO BOX 2597 3022 AIRPORT BLVD WATERLOO, IA 50704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 10.76% |
| PEDERSEN DOWIE CLABBY & MCCAUSLAND3 | PO BOX 2597 3022 AIRPORT BLVD WATERLOO, IA 50704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 9.56% |
| PEDERSEN DOWIE CLABBY & MCCAUSLAND3 | PO BOX 2597 3022 AIRPORT BLVD WATERLOO, IA 50704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
| PEDERSEN DOWIE CLABBY & MCCAUSLAND3 | PO BOX 2597 3022 AIRPORT BLVD WATERLOO, IA 50704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
| PDCM INSURANCE3 Filed as: PDCM INSURANCE, INC. | 622 PROGRESS AVENUE WATERLOO, IA 50701 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $1K | $0 | $1K | 10.00% |
| WELLMARK INC3 Filed as: WELLMARK, INC | 1331 GRAND AVENUE DES MOINES, IA 50309 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $81 | $0 | $81 | 0.64% |
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 | 184 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 51 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 235 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 240 | $1.5M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 124 | $13K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 170 | $50K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 127 | $20K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 117 | $35K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 170 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 240 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.