| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 10 SOUTH WACKER DRIVE, FLOOR 17 CHICAGO, IL 60606 | HARTFORD LIFE AND ACCIDENT | — | $9K | $9K | 1.61% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 400 HWY 169 S SAINT LOUIS PARK, MN 55426 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | — | $7K | 19.89% |
| STEVE BAKER4 | 153 ESTHER DRIVE COCOA BEACH, FL 32931 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $3K | — | $3K | 24.04% |
| USI INSURANCE SERVICES LLC4 Filed as: USI INS SERVICE NATIONAL INC. | 8331 NORMAN CENTER DRIVE, SUITE 500 BLOOMINGTON, MN 55413 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $548 | — | $548 | 4.70% |
| DAVID J. KLEINSMITH4 | P.O. BOX 1833 SAINT CLOUD, MN 56302 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $25 | — | $25 | 0.21% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MEDICA SELF-INSURED EIN 41-1479417 ADMINISTRATOR | Contract Administrator Service code 13 | — | $434K |
| DDMN ASO, LLC EIN 41-1905554 ADMINISTRATOR | Contract Administrator Service code 13 | — | $40K |
| BENEFIT EXTRAS, INC. ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 1815 BURNSVILLE, MN 55337 | $26K |
| WELLS FARGO INSURANCE SERVICES USA EIN 56-1882208 BROKER | Insurance agents and brokers Service code 22 | — | $7K |
| AIM HEALTHCARE SERVICES EIN 62-1451147 ADMINISTRATOR | Contract Administrator Service code 13 | — | $48 |
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 | 739 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 743 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE | 852 | $47K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 739 | $589K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 739 | $589K |
| Stop-loss / reinsurancereinsurance | MEDICA INSURANCE COMPANY | 1,252 | $892K |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 739 | $635K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,252 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.