| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $13K | $13K | 2.00% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 554025345 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $570 | $570 | 1.83% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES INC EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $535K |
| CALIFORNIA PHYSICIANS SERVICE EIN 94-0360524 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $202K |
| HAYS COMPANIES OF WISCONSIN BROKER | Insurance agents and brokers Service code 22 | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | $11K |
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 | 1,621 | 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) | 1,621 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 2,158 | $1.2M |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 2,158 | $147K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,621 | $662K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 66 | $31K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,621 | $662K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 157 | $2.0M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 4,000 | $666K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,000 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.