| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 3600 AMERICAN BLVD SUITE 500 BLOOMINGTON, MN 55431 | MEDICA INSURANCE COMPANY | $16K | $588 | $17K | 7.27% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 3600 AMERICAN BLVD SUITE 500 BLOOMINGTON, MN 55431 | DELTA DENTAL OF MINNESOTA | $11K | $0 | $11K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | TWO PIERCE PL - 21ST FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $0 | $6K | 14.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 3600 AMERICAN BLVD. W. SUITE 500 BLOOMINGTON, MN 55431 | LIFE INSURANCE COMPANY OF AMERICA (CIGNA) | $1K | $302 | $2K | 6.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 3600 AMERICAN BLVD W SUITE 500 BLOOMINGTON, MN 55431 | LIFE INSURANCE COMPANY OF AMERICA (CIGNA) | $187 | $292 | $479 | 1.79% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 3600 AMERICAN BLVD. W. SUITE 500 BLOOMINGTON, MN 55431 | LIFE INSURANCE COMPANY OF AMERICA (CIGNA) | $2K | $179 | $3K | 16.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 3600 AMERICAN BLVD. W. SUITE 500 BLOOMINGTON, MN 55431 | LIFE INSURANCE COMPANY OF AMERICA (CIGNA) | $2K | $161 | $3K | 16.02% |
| ANDREW JAMIN GRIMSLEY3 Filed as: ANDREW J. GRIMSLEY | 111 RAMBLING CREEK DR SE ST. MICHAEL, MN 55376 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $158 | $0 | $158 | 1.77% |
| EDWARD C. ROSENLUND3 | 8672 MEADOWVALE DR. EDEN PRAIRIE, MN 55347 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $49 | $0 | $49 | 0.55% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $49 | $0 | $49 | 0.55% |
| JILL R LAMBERT3 Filed as: JILL R. LAMBERT | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | $0 | $36 | 0.40% |
| ELIZABETH MARIE LANGEVIN3 Filed as: ELIZABETH M. LANGEVIN | 698 W. LARPENTEUR AVE. ST. PAUL, MN 55113 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | $0 | $9 | 0.10% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 3600 AMERICAN BLVD. W. SUITE 500 BLOOMINGTON, MN 55431 | LIFE INSURANCE COMPANY OF AMERICA (CIGNA) | $391 | $40 | $431 | 11.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MEDICA SELF-INSURED EIN 41-1479417 CLAIM PROCESSING | Claims processing Service code 12 | — | $86K |
| MEDICA | Claims processing Service code 12 | — | $8K |
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 | 142 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MINNESOTA | 106 | $106K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF AMERICA (CIGNA) | 97 | $43K |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF AMERICA (CIGNA) | 135 | $38K |
| Long-term disability | LIFE INSURANCE COMPANY OF AMERICA (CIGNA) | 108 | $16K |
| Stop-loss / reinsurancereinsurance | MEDICA INSURANCE COMPANY | 276 | $233K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 142 | $44K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 276 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.