| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SEVENHILLS CLEVELAND LLC3 | 7900 INTERNATIONAL DRIVE, SUITE 990 BLOOMINGTON, MN 55425 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 9.03% |
| SEVENHILLS CLEVELAND LLC3 | 7900 INTERNATIONAL DRIVE, SUITE 900 MINNEAPOLIS, MN 55425 | DELTA DENTAL OF MINNESOTA | $5K | — | $5K | 9.97% |
| ELIZABETH MARIE LANGEVIN3 | 698 W LARPENTEUR AVE ST PAUL, MN 55113 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $979 | $266 | $1K | 7.40% |
| SEVENHILLS CLEVELAND LLC | 7900 INTERNATIONAL DRIVE BLOOMINGTON, MN 55425 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 7.22% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $495 | $502 | $997 | 5.92% |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $453 | $153 | $606 | 3.60% |
| SUSAN MAE DANIEL3 Filed as: SUSAN G BOXRUD | 1804 MICHIGAN DRIVE NORTHFIELD, MN 55057 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $605 | — | $605 | 3.59% |
| NATALIE SUZANNE FONVILLE3 | 1600 THOMAS AVE N MINNEAPOLIS, MN 55411 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $266 | $234 | $500 | 2.97% |
| ROBERT SCOTT BRUNER3 | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $114 | $140 | $254 | 1.51% |
| EMPLOYEE BENEFIT ADVANTAGES INC3 | 14740 BOWERS DR NW RAMSEY, MN 55303 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $195 | — | $195 | 1.16% |
| DEACON CHARLES KAVANAUGH3 | 6336 HILL CREEK DR THE COLONY, TX 75056 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $60 | $19 | $79 | 0.47% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KLH INSURANCE INC | 886 POPLAR LN WATERTOWN, MN 55388 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $44 | — | $44 | 0.26% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 5500 WAYZATA BLVD MINNETONKA, MN 55416 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $37 | — | $37 | 0.22% |
| CARRIE S FLATEN3 | 2606 86TH CT W NORTHFIELD, MN 55057 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $37 | — | $37 | 0.22% |
| ATB INSURANCE INC3 | 6505 DEMPSEY AVE SW WAVERLY, MN 55390 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | $1 | $34 | 0.20% |
| KELLY CAROLE LARSON3 | 11026 ZUMBROTA CT NE BLAINE, MN 55449 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $2 | $28 | 0.17% |
| MPART BENEFITS INC3 | 100 ALBRIGHT LN PROSPER, TX 75078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $14 | $26 | 0.15% |
| DAVID M RYDEN3 | 2950 BENT TREE HILLS DR NEW BRIGHTON, MN 55112 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.10% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.10% |
| JILL R LAMBERT3 | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.05% |
| FLORENCE RYDEN3 | 2950 BENT TREE HILLS DR NEW BRIGHTON, MN 55112 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.04% |
| SEVENHILLS CLEVELAND LLC3 | 7900 INTERNATIONAL DRIVE, SUITE 990 MINNEAPOLIS, MN 55425 | DELTA DENTAL OF MINNESOTA | $1K | — | $1K | 9.91% |
| SEVENHILLS CLEVELAND LLC3 | 7900 INTERNATIONAL DRIVE, SUITE 900 BLOOMINGTON, MN 55425 | STANDARD INSURANCE COMPANY | $853 | — | $853 | 9.09% |
| SEVENHILLS CLEVELAND LLC4 Filed as: SEVENHILLS BENEFITS | 7900 INTERNATIONAL DRIVE, SUITE 900 BLOOMINGTON, MN 55425 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $180 | — | $180 | 13.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PREFERREDONE ADMIN. SERVICES, INC. EIN 41-1846481 ADMINISTRATOR | Contract Administrator Service code 13 | — | $22K |
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 | 113 | 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) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | DELTA DENTAL OF MINNESOTA | 100 | $58K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 113 | $26K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 30 | $17K |
| Long-term disability | STANDARD INSURANCE COMPANY | 113 | $47K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 30 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 113 | — |
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.