| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INSURANCE AGENCY | 1200 N MAYFAIR RD MILWAUKEE, WI 53226 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $57K | $0 | $57K | 13.19% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS AGENCY OF VA, INC | 11220 ASSETT LOOP STE 304 MANASSAS, VA 20109 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $24K | $24K | 5.58% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE #400 BLOOMINGTON, MN 55437 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 2.95% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MA 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $6 | $2K | 1.92% |
| JACQUELINE BARTHELEMY3 | 7573 HILTON ROAD ROYALTON, MN 56373 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 1.06% |
| ELIZABETH MARIE LANGEVIN3 | 698 W LARPENTEUR AVE ST. PAUL, MN 55113 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $480 | $0 | $480 | 0.39% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $388 | $0 | $388 | 0.31% |
| JON OLSON3 | 8662 CARRIAGE HILL RD SAVAGE, MN 55378 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $252 | $0 | $252 | 0.20% |
| LINDA R MARCUM3 | 1147 N. BROAD ST LEXINGTON, TN 38351 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $210 | $0 | $210 | 0.17% |
| BILLY MARK ROBERSON3 | 17415 SHADY CANYON SAN ANTONIO, TX 78248 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $205 | $0 | $205 | 0.17% |
| JILL R LAMBERT3 | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $201 | $0 | $201 | 0.16% |
| KINDA JACKSON3 | 1811 BROOKSIE THOMPSON RD DECATURVILLE, TN 38329 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $174 | $0 | $174 | 0.14% |
| MELISSA ARMATIS3 Filed as: MELISSA JEAN WOKASCH | 900 NORTH SHORE DR DETROIT LAKES, MN 56501 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $173 | $0 | $173 | 0.14% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC. | 80 S 8TH STREET MINNEAPOLIS, MN 55402 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $161 | $2 | $163 | 0.13% |
| WISER BENEFITS LLC3 | 7127 AVIGNON DR ROUND ROCK, TX 78681 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $163 | $0 | $163 | 0.13% |
| ASHLEY MARIA HOUTMAN3 | 3108 WESTEDGE BLVD MOUND, MN 55364 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $155 | $0 | $155 | 0.12% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KLH INSURANCE INC. | 6505 DEMPSEY AVE SW WAVERLY, MN 55390 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $62 | $2 | $64 | 0.05% |
| CARRIE S FLATEN3 | 2606 86TH CT W NORTHFIELD, MN 55057 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $63 | $0 | $63 | 0.05% |
| TR INSURANCE ADVISORS INC3 | 1009 EIGHTH AVE NE WASECA, MN 56093 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $38 | $0 | $38 | 0.03% |
| ZACKARY JAMES HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $34 | $0 | $34 | 0.03% |
| TYLER HERRINGTON TORBETT3 Filed as: TYLER JAMES JENDRO | 2019 4TH AVE N APT 202 SAUK RAPIDS, MN 56379 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $33 | $0 | $33 | 0.03% |
| ANDREW JAMIN GRIMSLEY3 | 1639 GOETTENS WAY SAINT CLOUD, MN 56301 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $21 | $0 | $21 | 0.02% |
| WENDY DAWN PACK3 Filed as: WENDY ELIZABETH BROWNING | 7127 AVIGNON DR ROUND ROCK, TX 78681 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $18 | $0 | $18 | 0.01% |
| DESIREE WENDELL3 | 39050 HARDER PKWY NORTH BRANCH, MN 55056 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $16 | $0 | $16 | 0.01% |
| CAROLYN GROVER3 | 206 FOX CHAPEL DR IRMO, SC 29063 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $13 | $0 | $13 | 0.01% |
| SABRINA S RAMOS3 | 13750 W. COLONIAL DR WINTER GARDEN, FL 34787 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $0 | $7 | 0.01% |
| MICHAEL A DUARTE3 | 515 DULL STREET DICKSON, TN 37055 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | $0 | $5 | 0.00% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 80 SOUTH 8TH STREET #700 MINNEAPOLIS, MN 55402 | EYEMED VISION CARE | $10K | $0 | $10K | 19.66% |
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 | 542 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 548 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE | 826 | $52K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 544 | $430K |
| Short-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 544 | $554K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 544 | $430K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 544 | $554K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 826 | — |
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.