| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 6.84% |
| USI INSURANCE SERVICES LLC | PO BOX 62889 VIRGINIA BEACH, VA 23466 | STANDARD INSURANCE COMPANY | $5K | — | $5K | 7.74% |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES NTL INC | 8000 NORMAN CENTER DR STE 400 BLOOMINGTON, MN 55437 | BCBSMN, INC. D.B.A BLUE CROSS BLUE SHIELD OF MINNNESOTA | $22K | — | $22K | — |
| USI INSURANCE SERVICES LLC Filed as: USI INSURANCE SERVICES NTL INC | 8000 NORMAN CENTER DR STE 400 BLOOMINGTON, MN 55437 | DELTA DENTAL OF WISCONSIN | $12K | — | $12K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BCBSMN EIN 41-0984460 THIRD PARTY ADMINISTRATOR | Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Legal; Claims processing Service code 12 | P.O. BOX 64560 ST PAUL, MN 55164 | $25K |
| USI INSURANCE SERVICES NTL INC THIRD PARTY ADMINISTRATOR | Insurance agents and brokers Service code 22 | 8000 NORMAN CENTER DR. STE 400 BLOOMINGTON, MN 55437 | $12K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 828 STEVEN POINT, WI 54481 | $12K |
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 | 390 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 390 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BCBSMN, INC. D.B.A BLUE CROSS BLUE SHIELD OF MINNNESOTA | 390 | $0 |
| Dental | DELTA DENTAL OF WISCONSIN | 225 | $0 |
| Life insurance | STANDARD INSURANCE COMPANY | 299 | $65K |
| Long-term disability | STANDARD INSURANCE COMPANY | 299 | $61K |
| Prescription drug | BCBSMN, INC. D.B.A BLUE CROSS BLUE SHIELD OF MINNNESOTA | 390 | $0 |
| Stop-loss / reinsurancereinsurance | BCBSMN, INC. D.B.A BLUE CROSS BLUE SHIELD OF MINNNESOTA | 390 | $0 |
| Other | STANDARD INSURANCE COMPANY | 299 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 390 | — |
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.