| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSOCIATED FINANCIAL GROUP LLC3 Filed as: ASSOCIATED FINANCIAL GROUP, LLC | 6000 CLEARWATER DRIVE MINNETONKA, MN 55343 | MEDICA INSURANCE COMPANY | $33K | $287 | $34K | 5.04% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE BLOOMINGTON, MN 55437 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $15K | $890 | $16K | 20.36% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $668 | $668 | 0.83% |
| JENNON M CARUTH3 Filed as: JENNON M. CARUTH | 7825 WASHINGTON AVENUE SOUTH SUITE 710 BLOOMINGTON, MN 55439 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $93 | $0 | $93 | 0.12% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | DELTA DENTAL OF MINNESOTA | $2K | $0 | $2K | 5.40% |
| ASSOCIATED FINANCIAL GROUP LLC3 Filed as: ASSOCIATED FINANCIAL GROUP, LLC | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | DELTA DENTAL OF MINNESOTA | $1K | $0 | $1K | 3.13% |
| USI INSURANCE SERVICES LLC3 | 711 EISENHOWER DRIVE KIMBERLY, WI 54136 | HUMANA INSURANCE COMPANY | $844 | $0 | $844 | 22.26% |
| JENNON M CARUTH3 Filed as: JENNON M. CARUTH | 7825 WASHINGTON AVENUE SOUTH SUITE 710 BLOOMINGTON, MN 55439 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $32 | $0 | $32 | 3.70% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE BLOOMINGTON, MN 55437 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $13 | $0 | $13 | 1.50% |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MEDICA INSURANCE COMPANY | 126 | $670K |
| Dental | DELTA DENTAL OF MINNESOTA | 113 | $41K |
| Vision | HUMANA INSURANCE COMPANY | 45 | $4K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 100 | $81K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 100 | $80K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 100 | $80K |
| Prescription drug | MEDICA INSURANCE COMPANY | 126 | $670K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 100 | $81K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 126 | — |
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.