| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS BENEFIT GROUP LLC | 80 S. 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | BCBSM, INC. D.B.A. BLUE CROSS AND BLUE SHIELD OF MINNESOTA | $43K | $4K | $46K | 1.88% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S. 8TH STREET MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $16K | $4K | $20K | 11.28% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S. 8TH STREET MINNEAPOLIS, MN 55402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $253 | $2K | 5.53% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $466 | $352 | $818 | 2.90% |
| EMPLOYEE BENEFIT ADVANTAGES INC3 Filed as: EMPLOYEE BENEFIT ADVANTAGES INC. | 14740 BOWERS DR NW RAMSEY, MN 55303 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $613 | $21 | $634 | 2.25% |
| ARLO I MATHISON3 | 28118 141ST ST NW ZIMMERMAN, MN 55398 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $396 | $15 | $411 | 1.46% |
| ELIZABETH MARIE LANGEVIN3 | 698 W LARPENTEUR AVE ST. PAUL, MN 55113 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $123 | $53 | $176 | 0.62% |
| DESIREE WENDELL3 | 40771 FENIAN WAY NORTH BRANCH, MN 55056 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $157 | $15 | $172 | 0.61% |
| JENNIFER B WILLIAMS3 | 17594 WIEDMAN WAY EDEN PRAIRIE, MN 55347 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $123 | $38 | $161 | 0.57% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $85 | $41 | $126 | 0.45% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC. | 3600 AMERICAN BOULEVARD WEST BLOOMINGTON, MN 55431 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $97 | — | $97 | 0.34% |
| CORY KENNETH KNUDSON3 | 2012 108TH LANE NW MINNEAPOLIS, MN 55433 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $80 | — | $80 | 0.28% |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $42 | $31 | $73 | 0.26% |
| KELLY CAROLE LARSON3 | 11026 ZUMBROTA CT NE BLAINE, MN 55449 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $51 | $4 | $55 | 0.19% |
| JILL R LAMBERT3 | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | — | $46 | 0.16% |
| EDWARD D SOMMER3 Filed as: EDWARD CHRIS ROSENLUND | 8672 MEADOWVALE DRIVE EDEN PRAIRIE, MN 55347 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.07% |
| ANDREW JAMIN GRIMSLEY3 | 111 RAMBLING CREEK DR SE SAINT MICHAEL, MN 55376 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.06% |
| COLIN J FLUEGEL3 | 11781 ZEA ST NW APT 106 MINNEAPOLIS, MN 55433 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.04% |
| JACK ALAN HENNINGSGAARD3 | 2562 LOST LAKE RD MOUND, MN 55364 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $2 | $9 | 0.03% |
| JEFFREY D HARNED3 Filed as: JEFFREY LYLES | 3872 BALLANTRAE RD EAGAN, MN 55122 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.02% |
| SAMANTHA L GRIMSLEY3 | 111 RAMBLING CREEK DRIVE ST MICHAELS, MN 55376 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| WORKSITE BENEFIT SERVICES3 | 8133 ROBINCREST CT FUQUAY VARINA, NC 27526 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
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 | 265 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 266 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BCBSM, INC. D.B.A. BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 473 | $2.5M |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 265 | $178K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 265 | $178K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 265 | $178K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 265 | $206K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 473 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.