| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $25K | $4K | $28K | 17.26% |
| DAVID J. KLEINSMITH4 | PO BOX 1833 SAINT CLOUD, MN 56302 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $634 | $0 | $634 | 10.35% |
| KCA MARKETING INC DBA LEGAL BENEFIT4 Filed as: KCA MARKETING INC. | DBA LEGAL BENEFIT CONSULTANTS PO BOX 1833 SAINT CLOUD, MN 56302 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $278 | $0 | $278 | 4.54% |
| MARK A. HANSON4 | 1006 7TH AVE SE BARNESVILLE, MN 56514 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $184 | $0 | $184 | 3.00% |
| MJ INSURANCE4 Filed as: DERYK B PETERSON AND VARIOUS AGENTS | 808 LE COVE CT VIRGINIA BEACH, VA 23464 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $96 | $0 | $96 | 1.57% |
| ALAN W. JUDD4 Filed as: ALAN W JUDD | 3532 LONG LAKE RD E SAINT PAUL, MN 55115 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $86 | $0 | $86 | 1.40% |
| JOCELYNE M. KLEINSMITH4 Filed as: JOCELYNE M KLEINSMITH | 514 3RD AVE NE SARTELL, MN 56377 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $79 | $0 | $79 | 1.29% |
| DIANNE M. CHURIK4 Filed as: DIANNE CHURIK | 10940 CROOKED LAKE BLVD N APT 424 MINNEAPOLIS, MN 55433 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $58 | $0 | $58 | 0.95% |
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 | 282 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 14 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 296 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 163 | $7K |
| Life insurance | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 282 | $164K |
| Short-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 282 | $164K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 282 | $164K |
| Other(2 contracts, 2 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 282 | $170K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 282 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.