Form 5500 · Employee benefit plan · URBANDALE, IA
UNIVERSAL PEDIATRIC SERVICES, INC.
The filing calls this plan UNIVERSAL PEDIATRIC SERVICES, INC. HEALTH & WELFARE PLAN.
UNIVERSAL PEDIATRIC SERVICES, INC. of URBANDALE, IA is a 115-participant health care and social assistance employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is HUB INTERNATIONAL MIDWEST LIMITED. Coverage is written through UNITED OF OMAHA LIFE INSURANCE COMPANY and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 42-1251522 · plan 505 · plan year 2025, filed Jul 13, 2026
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
Also declared: death benefits, other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 5 insured contracts covering vision, life and disability; the largest, with UNITED OF OMAHA LIFE INSURANCE COMPANY, covers 68 people.
The filing declares vision, life, disability, health and dental. Health and dental appear with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
Reported premium across the insured contracts is $103,473, with $11,130 in disclosed broker commissions — about 11% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
HUB INTERNATIONAL MIDWEST LIMITED is the broker of record on 4 of the 5 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 68 | Jan 1, 2026 | $45,744 | $3,702 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 84 | Jan 1, 2026 | $18,738 | $2,810 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 41 | Jan 1, 2026 | $15,970 | $2,316 |
| FIDELITY SECURITY LIFE INSURANCE COMPANY | Vision | 243 | Jan 1, 2026 | $21,833 | $2,183 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 42 | Jan 1, 2026 | $1,188 | $119 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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