| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $48K | $11K | $59K | 10.06% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $28 | $4K | 3.69% |
| JACQUELINE BARTHELEMY3 | 7573 HILTON ROAD ROYALTON, MN 56373 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $18 | $2K | 2.25% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $177 | $1K | 1.34% |
| KELLY CAROLE LARSON3 Filed as: KELLY C. LARSON AND OTHER AGENTS | 11026 ZUMBROTA COURT NE BLAINE, MN 55449 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $975 | $82 | $1K | 1.06% |
| MELISSA ARMATIS3 Filed as: MELISSA JEAN WOKASCH | 900 NORTH SHORE DRIVE DETROIT LAKES, MN 56501 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $799 | $0 | $799 | 0.80% |
| ASHLEY MARIA HOUTMAN3 | 5447 BREEZY ROAD MOUND, MN 55364 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $492 | $53 | $545 | 0.55% |
| DESIREE WENDELL3 | 38986 GRAND AVENUE NORTH BRANCH, MN 55056 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $417 | $0 | $417 | 0.42% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $16K | $0 | $16K | 17.78% |
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 | 1,030 | 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) | 1,030 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 1,265 | $91K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,030 | $582K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 147 | $99K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,030 | $582K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,030 | $681K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,265 | — |
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.