| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | P.O. BOX 95287 CHICAGO, IL 60694 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $38K | — | $38K | 17.49% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | — | MEDICA INSURANCE COMPANY | $17K | — | $17K | 9.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | P.O. BOX 95287 CHICAGO, IL 60694 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 7.46% |
| BREMER INSURANCE AGENCIES INC.3 | PO BOX 1000 LAKE ELMO, MN 55042 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 4.01% |
| JENNON M CARUTH3 | PO BOX 46122 EDEN PRAIRIE, MN 55344 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $35 | — | $35 | 0.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | P.O. BOX 95287 CHICAGO, IL 60694 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $678 | — | $678 | 5.49% |
| BREMER INSURANCE AGENCIES INC.3 | PO BOX 1000 LAKE ELMO, MN 55042 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $494 | — | $494 | 4.00% |
| JENNON M CARUTH3 | PO BOX 46122 EDEN PRAIRIE, MN 55344 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $121 | — | $121 | 0.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS INC | 2850 W GOLF RD, 11TH FLOOR ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $9 | $9 | 0.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DDMN ASO, LLC EIN 41-1852523 BENEFIT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $25K |
| MEDICA SELF INSURED EIN 41-1479417 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other fees; Claims processing Service code 12 | — | $9K |
| SAND CREEK EAP LLC EIN 41-1776423 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $8K |
| HEALTHEQUITY, INC. EIN 52-2383166 NONE | Direct payment from the plan Service code 50 | — | $8K |
| GALLAGHER BENEFIT SERVICES INC. EIN 36-4291971 NONE | Insurance agents and brokers Service code 22 | — | $1K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,439 | $228K |
| Stop-loss / reinsurancereinsurance | MEDICA INSURANCE COMPANY | 2,523 | $175K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,439 | $276K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,523 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.