| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PSH INSURANCE, INC.3 Filed as: PSH INSURANCE | 737 BISHOP STREET, SUITE 2120 HONOLULU, HI 96813 | UNIVERSITY HEALTH ALLIANCE | $14K | — | $14K | 5.00% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES | PO BOX 632886 CINCINNATI, OH 452632886 | HARTFORD LIFE AND ACCIDENT | — | $90 | $90 | 0.31% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ | P.O. BOX 632886 CINCINNATI, OH 45263 | EYEMED VISION CARE | $2K | — | $2K | 7.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BCBSMN EIN 41-0984460 NONE | Claims processing; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Contract Administrator Service code 12 | — | $99K |
| CBIZ BENEFITS & INSURANCE SERVICES EIN 31-1582098 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $41K |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $16K |
| DELTA DENTAL OF MINNESOTA EIN 41-1905554 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $9K |
| ALERUS EIN 45-0140105 NONE | Claims processing; Recordkeeping fees; Direct payment from the plan Service code 12 | — | $8K |
| PRIME THERAPEUTICS NONE | Claims processing; Contract Administrator; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 2900 AMES CROSSING ROAD EAGAN, MN 55121 | $6K |
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 | 177 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 182 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIVERSITY HEALTH ALLIANCE | 69 | $285K |
| Vision(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 177 | $306K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 127 | $29K |
| Prescription drug | UNIVERSITY HEALTH ALLIANCE | 69 | $285K |
| Stop-loss / reinsurancereinsurance | BCBSMN | 184 | $315K |
| Other | HARTFORD LIFE AND ACCIDENT | 127 | $29K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 184 | — |
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."
No prospect flags tripped on this filing.