| 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 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $1K | $8K | 11.64% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MINNESOTA INC. | 1600 UTICA AVE S MINNEAPOLIS, MN 55416 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 8.32% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $816 | $300 | $1K | 3.72% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $438 | $88 | $526 | 1.75% |
| KAREN BOHLER3 | 12810 PRIMROSE LANE EDEN PRAIRIE, MN 55344 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $391 | $115 | $506 | 1.69% |
| ELIZABETH MARIE LANGEVIN3 | 698 W LARPENTEUR AVE ST PAUL, MN 55113 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $368 | $53 | $421 | 1.40% |
| JILL R LAMBERT3 | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $222 | $11 | $233 | 0.78% |
| ANDREW JAMIN GRIMSLEY3 | 111 RAMBLING CREEK DR SE SAINT MICHAEL, MN 55376 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $189 | — | $189 | 0.63% |
| EDWARD D SOMMER3 Filed as: EDWARD CHRIS ROSENLUND | 8672 MEADOWVALE DRIVE EDEN PRAIRIE, MN 55347 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $172 | — | $172 | 0.57% |
| SAMANTHA L GRIMSLEY3 | 111 RAMBLING CREEK DRIVE ST MICHAELS, MN 55376 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $169 | — | $169 | 0.56% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $61 | $20 | $81 | 0.27% |
| TAMMY M DAHLBERG3 | 1009 EIGHTH AVE NE WASECA, MN 56093 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $61 | — | $61 | 0.20% |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDON, MN 55352 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $20 | $47 | 0.16% |
| MELISSA ARMATIS3 Filed as: MELISSA JEAN WOKASCH | 12549 STILKE LAKE RD FRAZEE, MN 56544 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.04% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S. 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $529 | $3K | 12.33% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S. 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $447 | $79 | $526 | 11.76% |
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 | 498 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 499 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 499 | $67K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 303 | $23K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 498 | $34K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 499 | — |
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.