| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $1K | $6K | 10.47% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 6.37% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $1K | $6K | 10.80% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 6.28% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $552 | $61 | $613 | 9.82% |
| M3 INSURANCE SOLUTIONS INC3 | 828 JOHN NOLEN DRIVE MADISON, WI 53713 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $385 | — | $385 | 6.17% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $372 | $10 | $382 | 6.35% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $157 | $143 | $300 | 4.99% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KLH INSURANCE, INC. | 886 POPLAR LANE WATERTOWN, MN 55388 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $109 | $7 | $116 | 1.93% |
| TR INSURANCE ADVISORS INC3 | 1009 EIGHTH AVE NE WASECA, MN 56093 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $79 | $1 | $80 | 1.33% |
| MPART BENEFITS INC3 | 100 ALBRIGHT LN PROSPER, TX 75078 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $24 | $32 | $56 | 0.93% |
| PAMELA JEAN DESHAW-BRACKETT3 | 6518 WEST HUNTER LAKE ROAD DULUTH, MN 55803 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $52 | — | $52 | 0.86% |
| NATIONAL ENROLLMENT PARTNERS LLC3 | C/0 NATL ENROLLMENT PARTNERS CRANSTON, RI 02920 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.52% |
| MEGHAN MOFFATT LUCAS3 Filed as: MEGHAN MOFATT LUCAS | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.35% |
| ELIZABETH MARIE LANGEVIN3 | 51685 BELLE ISLE DR RUSH CITY, MN 55069 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.35% |
| JILL R LAMBERT3 Filed as: JILL R. LAMBERT | 12741 JEFFERSON STREET NE BLAINE, MN 55434 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.22% |
| ROBERT SCOTT BRUNER3 Filed as: ROBERT SCOTT BURNER | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $8 | $4 | $12 | 0.20% |
| GARSON FINANCIAL SERVICES S C3 | 929 N ASTOR ST UNIT 1406 MILWAUKEE, WI 53202 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.13% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 243 | $57K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 7 | $6K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 243 | $55K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 243 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 243 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.