| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LEFTLANE INC3 Filed as: LEFTLANE, INC | 2145 FORD PARKWAY #200 SAINT PAUL, MN 551161900 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $9K | $0 | $9K | 15.00% |
| LEFTLANE INC3 Filed as: LEFTLANE, INC. | 2145 FORD PARKWAY #200 SAINT PAUL, MN 551161900 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $0 | $3K | 15.00% |
| LEFTLANE INC3 Filed as: LEFTLANE, INC. | 2145 FORD PARKWAY #200 ST. PAUL, MN 55116 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $610 | $354 | $964 | 31.61% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| 40 SQUARE COOPERATIVE SOLUTIONS EIN 35-2605951 PLAN SPONSOR | Consulting (general) Service code 16 | — | $373K |
| EBSO, INC EIN 39-1277023 NONE | Contract Administrator Service code 13 | — | $239K |
| ADVISOR NET FINANCIAL EIN 41-1378662 NONE | Insurance agents and brokers Service code 22 | — | $95K |
| IFC EIN 04-3757825 NONE | Insurance agents and brokers Service code 22 | — | $63K |
| ALITHIAS EIN 45-1698178 NONE | Claims processing Service code 12 | — | $52K |
| CONCORD MANAGEMENT RESOURCES EIN 82-2339246 NONE | Consulting (general) Service code 16 | — | $47K |
| WINDSOR STRATEGY PARTNERS EIN 81-0912547 NONE | Actuarial Service code 11 | — | $46K |
| TRUSTED ACRES EIN 82-3689697 NONE | Insurance agents and brokers Service code 22 | — | $30K |
| SMART DATA SOLUTIONS EIN 41-2006324 NONE | Other services Service code 49 | — | $30K |
| FARMERS UNION INSURANCE AGENCY EIN 41-0808644 NONE | Insurance agents and brokers Service code 22 | — | $22K |
| AMY NESEMEIER - AGRASURE EIN 45-0374998 NONE | Insurance agents and brokers Service code 22 | — | $17K |
| STRATEGIC UNDERWRITING SOLUTIONS EIN 20-5848687 NONE | Insurance services Service code 23 | — | $10K |
| DEFINITIVE INSURANCE MANAGEMENT EIN 26-1757843 NONE | Legal Service code 29 | — | $9K |
| RISTY BENEFITS EIN 20-0692245 NONE | Insurance agents and brokers Service code 22 | — | $8K |
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 | 477 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 477 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | RELIANCE STANDARD LIFE INSURANCE COMPANY | 140 | $60K |
| Vision | RELIANCE STANDARD LIFE INSURANCE COMPANY | 184 | $20K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 22 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 184 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.