| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 80 SOUTH 8TH ST MINNEAPOLIS, MN 55402 | HEALTHPARTNERS | $36K | $0 | $36K | 2.05% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 SO. 8TH ST. SUITE 700 MINNEAPOLIS, MN 55402 | SUN LIFE ASSURANCE COMPANY OF CANADA | $7K | $1K | $8K | 9.38% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 SO. 8TH ST. SUITE 700 MINNEAPOLIS, MN 55402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $77 | $2K | 3.71% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $953 | $296 | $1K | 2.86% |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $504 | $148 | $652 | 1.49% |
| ZACKARY JAMES HALLER3 Filed as: ZACKARY HALLER | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $306 | $24 | $330 | 0.75% |
| ROSE MARY GOODMAN3 | 5200 HOLLY LN. N. #4 PLYMOUTH, MN 55446 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $251 | $5 | $256 | 0.59% |
| MEGHAN MOFFATT LUCAS3 Filed as: MEGHAN LUCAS | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $188 | $28 | $216 | 0.49% |
| JON OLSON3 | 5650 W. 36TH ST. APT. 509 ST. LOUIS PARK, MN 55416 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $196 | $11 | $207 | 0.47% |
| ELIZABETH MARIE LANGEVIN3 Filed as: ELIZABETH LANGEVIN | 698 W LARPENTEUR AVE ST PAUL, MN 55113 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $160 | $27 | $187 | 0.43% |
| MELONY LEE MICHAELS3 Filed as: MELONY MICHEALS | 4200 WEDGEWOOD LANE N PLYMOUTH, MI 55442 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $133 | — | $133 | 0.30% |
| JILL R LAMBERT3 Filed as: JILL LAMBERT | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $108 | $14 | $122 | 0.28% |
| CARRIE S FLATEN3 Filed as: CARRIE FLATEN | 2606 86TH CT W NORTHFIELD, MN 55057 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $58 | $4 | $62 | 0.14% |
| CURTIS LARSON3 | 11626 YUKON ST. NW COON RAPIDS, MN 55433 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $43 | $1 | $44 | 0.10% |
| TYLER DOUGLAS NOLL3 | 13246 POSTIER DR NW ORONOCO, MN 55960 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | $1 | $40 | 0.09% |
| JENNIFER GROVE3 | 25900 AUTMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.03% |
| ROBERT SCOTT BRUNER3 Filed as: ROBERT BRUNER | 987 LACY CT BELLE PLAINE, MN 56011 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $5 | $13 | 0.03% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KLH INSURANCE INC | 3357 POLK ST. NE MINNEAPOLIS, MN 55418 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | $1 | $7 | 0.02% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS BENEFITS GROUP, LLC | 80 SO. 8TH ST. SUITE 700 MINNEAPOLIS, MN 55402 | STANDARD INSURANCE COMPANY | $3K | $1K | $5K | 11.51% |
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 | 176 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 178 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTHPARTNERS | 300 | $1.8M |
| Dental | HEALTHPARTNERS | 300 | $1.7M |
| Life insurance | STANDARD INSURANCE COMPANY | 174 | $41K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 178 | $82K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 178 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 300 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.