| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 400 BLOOMINGTON, MN 55437 | MEDICA INSURANCE COMPANY | $120K | $2K | $122K | 4.06% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DRIVE, SUITE 400 VALHALLA, NY 10595 | DELTA DENTAL OF MINNESOTA | $5K | $0 | $5K | 2.75% |
| USI INSURANCE SERVICES LLC3 | 8331 NORMAN CENTER DRIVE, SUITE 500 MINNEAPOLIS, MN 55437 | HARTFORD LIFE AND ACCIDENT | $20K | $0 | $20K | 11.59% |
| USI INSURANCE SERVICES LLC3 | 470 PARK AVENUE SOUTH, 6TH FLOOR NEW YORK, NY 10016 | HARTFORD LIFE AND ACCIDENT | $0 | $11K | $11K | 6.14% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 5.63% |
| MARC A GROVE3 Filed as: MARC A. GROVE AND OTHER AGENTS | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $549 | $44 | $593 | 1.67% |
| SHARON L. KONIECZNY3 | 12610 50TH AVENUE PLYMOUTH, MN 55442 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $405 | $0 | $405 | 1.14% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $356 | $0 | $356 | 1.00% |
| NATALIE SUZANNE FONVILLE3 | 1600 THOMAS AVENUE NORTH MINNEAPOLIS, MN 55411 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $179 | $94 | $273 | 0.77% |
| CARRIE S FLATEN3 Filed as: CARRIE S. FLATEN | 2606 86TH COURT WEST NORTHFIELD, MN 55057 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $272 | $0 | $272 | 0.77% |
| LACIE M SWARTZENDRUBER3 Filed as: LACIE M. SWARTZENDRUBER | 4119 SHERIDAN AVENUE NORTH MINNEAPOLIS, MN 55412 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $232 | $3 | $235 | 0.66% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | PO BOX 203373 DALLAS, TX 75320 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $2K | $0 | $2K | 9.12% |
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 | 371 | 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) | 371 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MEDICA INSURANCE COMPANY | 496 | $3.0M |
| Dental | DELTA DENTAL OF MINNESOTA | 496 | $191K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 380 | $24K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 371 | $172K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 371 | $172K |
| Prescription drug | MEDICA INSURANCE COMPANY | 496 | $3.0M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 371 | $207K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 496 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.