| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY, LLC | 7225 NORTHLAND DRIVE NORTH SUITE 300 BROOKLYN PARK, MN 55428 | BCBSM, INC. D.B.A. BLUE CROSS AND BLUE SHIELD OF MINNESOTA | — | $6K | $6K | 1.51% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY, LLC | 7225 NORTHLAND DRIVE NORTH SUITE 300 BROOKLYN PARK, MN 55428 | DELTA DENTAL OF MINNESOTA | $20K | — | $20K | 10.02% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY, LLC | 7225 NORTHLAND DRIVE NORTH SUITE 300 BROOKLYN PARK, MN 55428 | FIDELITY SECURITY LIFE INSURANCE COMPANY - EYEMED | $976 | — | $976 | 9.90% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF MN EIN 41-0984460 CONTRACT ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Float revenue; Other fees; Claims processing Service code 12 | P.O. BOX 64560 ST. PAUL, MN 55164 | $140K |
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 | 254 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 21 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 277 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MINNESOTA | 464 | $197K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY - EYEMED | 209 | $10K |
| Stop-loss / reinsurancereinsurance | BCBSM, INC. D.B.A. BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 491 | $371K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 491 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.