| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHS INSURANCE SERVICES, LLC3 | PO BOX 64089 ST. PAUL, MN 551640089 | METROPOLITAN LIFE INSURANCE COMPANY | $225K | $21K | $246K | 4.42% |
| CHS INSURANCE SERVICES, LLC3 | P.O. BOX 64089 ST. PAUL, MN 551640089 | ACE AMERICAN INSURANCE COMPANY | $14K | — | $14K | 15.00% |
| CHS INSURANCE SERVICES, LLC3 | P.O. BOX 64089 ST. PAUL, MN 551640089 | ACE AMERICAN INSURANCE COMPANY | $8K | $0 | $8K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MINNESOTA EIN 41-0984460 NONE | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Contract Administrator Service code 12 | — | $5.0M |
| THE STAYWELL COMPANY EIN 13-2890345 NONE | Other services Service code 49 | — | $837K |
| DELTA DENTAL OF MINNESOTA EIN 41-1905554 NONE | Claims processing Service code 12 | — | $328K |
| MAYO CLINIC HEALTH SOLUTIONS EIN 41-1506440 NONE | Other services Service code 49 | — | $164K |
| WAGEWORKS EIN 94-3351864 NONE | Claims processing Service code 12 | — | $161K |
| EYEDMED - VISION PLAN ADMINISTRATOR EIN 86-0773195 NONE | Claims processing Service code 12 | — | $124K |
| MII LIFE INCORPORATED DBA SELECTACC EIN 41-6019132 NONE | Claims processing Service code 12 | — | $38K |
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 | 8,138 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 531 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 8,669 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 8,335 | $5.6M |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 8,335 | $5.6M |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MINNESOTA | 7,534 | $746K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 8,335 | $5.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,335 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.