| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 6000 CLEARWATER DRIVE MINNETONKA, MN 55343 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $19K | $2K | $21K | 11.24% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE BLOOMINGTON, MN 55437 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $517 | $3K | $4K | 2.02% |
| JENNON M CARUTH3 Filed as: JENNON M. CARUTH | 7825 WASHINGTON AVENUE SOUTH SUITE 710 BLOOMINGTON, MN 55439 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $61 | $2K | 0.86% |
| JENNON M CARUTH3 Filed as: JENNON M. CARUTH | 7825 WASHINGTON AVENUE SOUTH SUITE 710 BLOOMINGTON, MN 55439 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $14K | $916 | $15K | 8.36% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE BLOOMINGTON, MN 55437 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $340 | $5K | 2.81% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $966 | $0 | $966 | 0.55% |
| RICHARD J. HEINRICH3 | 13921 BLENHEIM TRAIL ROAD FORT MYERS, FL 33908 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $432 | $0 | $432 | 0.25% |
| USI INSURANCE SERVICES LLC3 | 6000 CLEARWATER DRIVE MINNETONKA, MN 55343 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $363 | $0 | $363 | 0.21% |
| AHMANN MARTIN3 Filed as: AHMANN AND MARTIN COMPANY | 7555 MARKET PLACE DRIVE EDEN PRAIRIE, MN 55344 | RELIASTAR LIFE INSURANCE COMPANY | $2K | $0 | $2K | 0.93% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE BLOOMINGTON, MN 55437 | UNITEDHEALTHCARE INSURANCE COMPANY | $3K | $0 | $3K | 10.00% |
| USI INSURANCE SERVICES LLC3 | 312 ELM STREET, 24TH FLOOR CINCINNATI, OH 45202 | UNITEDHEALTHCARE INSURANCE COMPANY | $0 | $956 | $956 | 3.43% |
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 | 314 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 323 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 235 | $28K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 444 | $362K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 401 | $176K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 444 | $186K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 563 | $357K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 563 | — |
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.