| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: BLUE CROSS AND BLUE SHIELD OF MINNE | P.O. BOX 64560 ST. PAUL, MN 55164 | BCBSMN, INC. D.B.A BLUE CROSS BLUE SHIELD OF MINNESOTA | $42K | — | $42K | 5.19% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHEILD OF MINNESOTA EIN 41-0984460 BUSINESS RELATIONSHIP | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $5.2M |
| EXPRESS SCRIPTS EIN 23-3461740 BUSINESS RELATIONSHIP | Contract Administrator; Claims processing Service code 12 | — | $437K |
| LIMEADE BUSINESS RELATIONSHIP | Other services Service code 49 | 10885 NE 4TH STREET STE 400 BELLEVUE, WA 98004 | $425K |
| DELTA DENTAL EIN 41-1905554 BUSINESS RELATIONSHIP | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | — | $340K |
| TIVITY HEALTH BUSINESS RELATIONSHIP | Other services Service code 49 | 4031 ASPEN GROVE DRIVE SUITE 250 FRANKLIN, TN 37067 | $274K |
| TELADOC HEALTH, INC EIN 04-3705970 BUSINESS RELATIONSHIP | Other services Service code 49 | — | $237K |
| TANGO CARD, INC BUSINESS RELATIONSHIP | Other services Service code 49 | 4700 42ND AVE SW STE 430A SEATTLE, WA 98116 | $124K |
| WIN FERTILITY BUSINESS RELATIONSHIP | Other services Service code 49 | 1 AMERICAN LANE - TERRACE LEVEL GREENWICH, CT 06831 | $98K |
| JELLYVISION LAB, INC BUSINESS RELATIONSHIP | Other services Service code 49 | 848 W EASTMAN ST SUITE 104 CHICAGO, IL 60642 | $91K |
| OVULINE, INC. DBA OVIA HEALTH BUSINESS RELATIONSHIP | Other services Service code 49 | 263 SUMMER ST 6TH FLOOR BOSTON, MA 02210 | $73K |
| COMERICA EIN 38-0477375 TRUSTEE & PARTY-IN-INTERE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $7K |
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 | 8,300 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 283 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 8,583 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | BCBSMN, INC. D.B.A BLUE CROSS BLUE SHIELD OF MINNESOTA | 8,583 | $805K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,583 | — |
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.