| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TIC INC3 | 701 SAND LAKE COULEE RD ONALASKA, WI 54650 | BCBSMN, INC DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | $12K | — | $12K | 2.74% |
| ASSOCIATED FINANCIAL GROUP LLC3 | 711 EISENHOWER DR KIMBERLY, WI 54136 | BCBSMN, INC DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | $12K | — | $12K | 2.74% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC-MOUNTAIN | PO BOX 62817 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 3.78% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DR, STE 4 BLOOMINGTON, MN 55437 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 3.30% |
| TIC INC3 | 701 SAND LAKE COULEE RD ONALASKA, WI 54650 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 1.64% |
| ASSOCIATED FINANCIAL GROUP LLC3 | 711 EISENHOWER DR KIMBERLY, WA 54136 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 1.10% |
| DIRECT BENEFITS INC3 Filed as: DIRECT BENEFITS, INC | 55 E 5TH ST, STE 500 ST PAUL, MN 55101 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $528 | — | $528 | 6.00% |
| TIC INC3 | 701 SAND LAKE COULEE RD ONALASKA, WI 54650 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $432 | — | $432 | 4.91% |
| ASSOCIATED FINANCIAL GROUP LLC3 | 12600 WHITEWATER DR, STE 100 MINNETONKA, MN 55343 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $376 | — | $376 | 4.27% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $115 | — | $115 | — |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DR, STE 400 BLOOMINGTON, MN 55437 | SUN LIFE ASSURANCE COMPANY OF CANADA | $77 | — | $77 | — |
| TIC INC3 | 701 SAND LAKE COULEE RD ONALASKA, WI 54650 | SUN LIFE ASSURANCE COMPANY OF CANADA | $37 | — | $37 | — |
| ASSOCIATED FINANCIAL GROUP LLC3 | 711 EISENHOWER DR KIMBERLY, WI 54136 | SUN LIFE ASSURANCE COMPANY OF CANADA | $28 | — | $28 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BCBSMN, INC | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Contract Administrator Service code 12 | — | $72K |
| BXBSMN, INC EIN 41-0984460 CLAIMS PROCESSING,RECORDS | Other fees; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | PO BOX 64560 ST PAUL, MN 55164 | $56K |
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 | 106 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BCBSMN, INC DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 251 | $437K |
| Dental | DDMN ASO, LLC | 298 | $0 |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 119 | $9K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 128 | $111K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 0 | $0 |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 128 | $111K |
| Stop-loss / reinsurancereinsurance | BCBSMN, INC DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 251 | $437K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 298 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.