| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PREFERRED BENEFIT CONCEPTS, INC.3 Filed as: PREFERRED BENEFIT CONCEPTS | 8881 AZTEC DR EDEN PRAIRIE, MN 55347 | STARMOUNT LIFE INSURANCE COMPANY | $8K | $10K | $19K | 4.53% |
| PREFERRED BENEFIT CONCEPTS, INC.3 Filed as: PREFERRED BENEFIT CONCEPTS | 8881 AZTEC DR EDEN PRAIRIE, MN 55347 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $10K | — | $10K | 5.00% |
| PREFERRED BENEFIT CONCEPTS, INC.3 Filed as: PREFERRED BENEFIT CONCEPT | 8881 AZTEC DR EDEN PRAIRIE, MN 55347 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 2.31% |
| PREFERRED BENEFIT CONCEPTS, INC.3 Filed as: PREFERRED BENEFIT CONCEPTS INC | 8881 AZTEC DR EDEN PRAIRIE, MN 55347 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 6.15% |
| PREFERRED BENEFIT CONCEPTS, INC.3 Filed as: PREFERRED BENEFIT CONCEPTS INC | 8881 AZTEC DR EDEN PRAIRIE, MN 55347 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 3.61% |
| PREFERRED BENEFIT CONCEPTS, INC.3 Filed as: PREFERRED BENEFIT CONCEPTS | 8881 AZTEC DR EDEN PRAIRIE, MN 55347 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $726 | — | $726 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BCBSMN, INC EIN 41-0984460 NONE | Contract Administrator; Claims processing; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | PO BOX 64560 ST PAUL, MN 55164 | $204K |
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 | 690 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 695 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | STARMOUNT LIFE INSURANCE COMPANY | 663 | $414K |
| Vision(2 contracts, 2 carriers) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 837 | $54K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 852 | $217K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 637 | $190K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 539 | $78K |
| Stop-loss / reinsurancereinsurance | BCBSMN, INC, D.B.A. BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 693 | $338K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 852 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.