| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WELLS FARGO INSURANCE SERVICES Filed as: WELL FARGO INS SERVICES OF MN | 1801 PARK VIEW DRIVE SHOREVIEW, MN 55126 | SUN LIFE ASSURANCE COMPANY OF CANADA | $17K | — | $17K | 12.28% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: WELLS FARGO INS SERVICES OF MN | 1801 PARK VIEW DRIVE SHOREVIEW, MN 55126 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: WELLS FARGO INS SERVICES OF MN | 1801 PARK VIEW DRIVE SHOREVIEW, MN 55126 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 15.00% |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: WELLS FARGO INSURANCE | 400 HWY 169 SOUTH 8TH FLOOR ST. LOUIS PARK, MN 55426 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INS COMPANY | $932 | — | $932 | 10.18% |
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 | 254 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 125 | Continuation coverage (COBRA, retiree health). |
| Beneficiaries receiving benefits | 39 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 418 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INS COMPANY | 142 | $9K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 384 | $136K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 138 | $72K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 88 | $27K |
| Stop-loss / reinsurancereinsurance | MEDICA INSURANCE COMPANY | 764 | $321K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 764 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.