| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEUSA LLC3 | 1851 LAKE DRIVE WEST SUITE 350 CHANHASSEN, MN 55317 | USABLE LIFE | $907 | $0 | $907 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF MINNE EIN 41-0984460 NONE | Float revenue; Other fees; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | PO BOX 64560 ST. PAUL, MN 55164 | $73K |
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 | 280 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 280 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 683 | $152K |
| Vision | BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 683 | $152K |
| Life insurance | USABLE LIFE | 332 | $6K |
| Stop-loss / reinsurancereinsurance | BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 683 | $152K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 683 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.