| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEVELAND MAHER LLC3 | 1650 W 82ND ST BLOOMINGTON, MN 55431 | BCBM INC | $191K | $9K | $199K | 2.43% |
| CLEVELAND MAHER LLC3 | 1650 W 82ND ST BLOOMINGTON, MN 55431 | COLONIAL LIFE | $7K | $0 | $7K | 5.44% |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE | $3K | $777 | $4K | 3.13% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE | $2K | $926 | $3K | 2.29% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE | $1K | $485 | $2K | 1.40% |
| JAMIE MCREYNOLDS3 | 4550 MINNETONKA BLVD MINNEAPOLIS, MN 55416 | COLONIAL LIFE | $1K | $0 | $1K | 1.08% |
| KAREN BOHLER3 | 12810 PRIMROSE LANE EDEN PRAIRIE, MN 55344 | COLONIAL LIFE | $552 | $108 | $660 | 0.51% |
| LAURA B WETT3 | 8496 100TH ST E NORTHFIELD, MN 55057 | COLONIAL LIFE | $533 | $67 | $600 | 0.46% |
| ELIZABETH MARIE LANGEVIN3 | 698 W LARPENTEUR AVE ST PAUL, MN 55113 | COLONIAL LIFE | $437 | $141 | $578 | 0.44% |
| ROBERT SCOTT BRUNER3 | 987 LACY CT BELLE PLAINE, MN 56011 | COLONIAL LIFE | $432 | $124 | $556 | 0.43% |
| ANDREW CHARLES FELLS3 | 331 W HUMPHREY STREET LAKE CRYSTAL, MN 56055 | COLONIAL LIFE | $423 | $108 | $531 | 0.41% |
| JEFFREY D HARNED3 Filed as: JEFFREY LYLES | 3872 BALLANTRAE RD EAGAN, MN 55122 | COLONIAL LIFE | $504 | $0 | $504 | 0.39% |
| JENNIFER B WILLIAMS3 | 17594 WIEDMAN WAY EDEN PRAIRIE, MN 55347 | COLONIAL LIFE | $412 | $88 | $500 | 0.38% |
| ZACKARY JAMES HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE | $381 | $30 | $411 | 0.32% |
| ANDREW JAMIN GRIMSLEY3 | 111 RAMBLING CREEK DR SE ST MICHAEL, MN 55376 | COLONIAL LIFE | $217 | $34 | $251 | 0.19% |
| ANNA JANICE RUIZ3 Filed as: ANNA KRISTINA DUDECK | 1164 MERRIFIELD COURT SHAKOPEE, MN 55379 | COLONIAL LIFE | $190 | $0 | $190 | 0.15% |
| DESIREE WENDELL3 | 40771 FENIAN WAY NORTH BRANCH, MN 55056 | COLONIAL LIFE | $185 | $0 | $185 | 0.14% |
| JILL R LAMBERT3 | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE | $117 | $5 | $122 | 0.09% |
| KELLY CAROLE LARSON3 | 11026 ZUMBROTA CT NE BLAINE, MN 55449 | COLONIAL LIFE | $91 | $5 | $96 | 0.07% |
| JAMIE E LAWLESS3 | 9010 GARLAND LANE N MAPLE GROVE, MN 55311 | COLONIAL LIFE | $51 | $0 | $51 | 0.04% |
| ANJI ECKER JANES3 | 4415 DELLWOOD ST ARDEN HILLS, MN 55112 | COLONIAL LIFE | $50 | $0 | $50 | 0.04% |
| JACK ALAN HENNINGSGAARD3 | 2562 LOST LAKE RD MOUND, MN 55364 | COLONIAL LIFE | $26 | $3 | $29 | 0.02% |
| SUSAN MAE DANIEL3 Filed as: SUSAN G BOXRUD | 1804 MICHIGAN DRIVE NORTHFIELD, MN 55057 | COLONIAL LIFE | $22 | $1 | $23 | 0.02% |
| JENNIFER GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE | $12 | $6 | $18 | 0.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 3600 AMERICAN BOULEVARD WEST BLOOMINGTON, MN 55431 | COLONIAL LIFE | $5 | $0 | $5 | 0.00% |
| CLEVELAND MAHER LLC3 | 1650 W 82ND STREET # 880 MINNEAPOLIS, MN 55431 | SYMETRA FINANCIAL | $9K | — | $9K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FORMULA CORPORATION EIN 41-1559435 NONE | Claims processing; Contract Administrator Service code 12 | — | $213K |
| ALTON JOHNSON NONE | Other services Service code 49 | 3541 COLFAX AVE S MINNEAPOLIS, MN 55408 | $23K |
| BETTS & HAYES LTD EIN 41-1619880 NONE | Accounting (including auditing) Service code 10 | — | $21K |
| THOMAS M HUGHES LTD EIN 26-3097969 NONE | Legal Service code 29 | — | $15K |
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 | 897 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 900 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BCBM INC | 1,897 | $8.3M |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE | 712 | $131K |
| Short-term disability | COLONIAL LIFE | 712 | $130K |
| Long-term disability | COLONIAL LIFE | 712 | $130K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE | 712 | $131K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,897 | — |
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.