| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 3600 AMERICAN BOULEVARD WEST SUITE 500 BLOOMINGTON, MN 55431 | BCBSMN, INC., DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | $136K | $21K | $156K | 17.56% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BCBSM, INC. EIN 41-0984460 ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $1.6M |
| DELTA DENTAL EIN 41-1905554 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $69K |
| DELOITTE TAX LLP EIN 86-1065772 ACTUARIAL | Actuarial Service code 11 | — | $26K |
| RSM US LLP EIN 41-0714325 ACCOUNTING | Accounting (including auditing) Service code 10 | — | $18K |
| HR SIMPLIFIED ADMINISTRATOR | Contract Administrator Service code 13 | 5320 WEST 23RD STREET, SUITE 350 MINNEAPOLIS, MN 55416 | $13K |
| USBANK EIN 31-0841368 TRUST FEE | Account maintenance fees Service code 65 | — | $13K |
| HEALICS WELLNESS INC. BIOMETRIC HEALTH SCREEN | Insurance services Service code 23 | 8919 WEST HEATHER AVENUE MILWAUKEE, WI 53224 | $5K |
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 | 1,279 | 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) | 1,279 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BCBSMN, INC., DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 2,961 | $891K |
| Stop-loss / reinsurancereinsurance | BCBSMN, INC., DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 2,961 | $891K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,961 | — |
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.