| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SUPERIOR BENEFIT ADVISORS LLC3 | 3500 AMERICAN BLVD W, SUITE 450 BLOOMINGTON, MN 55431 | UNITEDHEALTHCARE INSURANCE COMPANY | $105K | $0 | $105K | 1.02% |
| SUPERIOR BENEFIT ADVISORS LLC3 | 3500 AMERICAN BLVD W, SUITE 450 BLOOMINGTON, MN 55431 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $3K | $3K | 2.95% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FORMULA CORPORATION EIN 41-1559435 NONE | Claims processing; Contract Administrator Service code 12 | — | $304K |
| BETTS & HAYES LTD EIN 41-1619880 NONE | Accounting (including auditing) Service code 10 | — | $42K |
| JBK CONSULTING LLC NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 3011 EARL RUDDER FRWY SOUTH COLLEGE STATION, TX 77845 | $29K |
| THOMAS M HUGHES LTD EIN 26-3097969 NONE | Legal Service code 29 | — | $12K |
| METRO SALES INC NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 250 N RIVER RIDGE CIRCLE BURNSVILLE, MN 55337 | $8K |
| ALTON JOHNSON NONE | Other services Service code 49 | 3541 COLFAX AVE S MINNEAPOLIS, MN 55408 | $7K |
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 | 870 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 872 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 1,875 | $10.2M |
| Life insurance | UNITEDHEALTHCARE INSURANCE COMPANY | 667 | $33K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 705 | $113K |
| Other | UNITEDHEALTHCARE INSURANCE COMPANY | 667 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,875 | — |
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.