| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 | PO BOX 632886 CINCINNATI, OH 45263 | BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | — | $9K | $9K | 2.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF MN EIN 41-0984460 NONE | Float revenue; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | — | $289K |
| DELTA DENTAL OF MINNESOTA EIN 41-1905554 NONE | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $33K |
| WELLVATION, LLC EIN 26-1654987 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $27K |
| ALERUS FINANCIAL EIN 45-0375407 NONE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $23K |
| HEALTH STRATEGIES EIN 41-1998260 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $14K |
| MESSERLI & SCHADOW PLLP EIN 41-1653318 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $13K |
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 | 700 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 705 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance | BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 1,306 | $421K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,306 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.