| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | PREFERREDONE INSURANCE COMPANY | $21K | $0 | $21K | 3.25% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE BLOOMINGTON, MN 55437 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $867 | $4K | 18.86% |
| PLANSOURCE BENEFIT ADMINISTRATION3 | PO BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $224 | $0 | $224 | 1.00% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 100 BLOOMINGTON, MN 55437 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $405 | $0 | $405 | 2.17% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $142 | $38 | $180 | 0.96% |
| CARRIE S FLATEN3 Filed as: CARRIE S. FLATEN | 2606 86TH COURT WEST NORTHFIELD, MN 55057 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $141 | $0 | $141 | 0.75% |
| TR INSURANCE ADVISORS INC3 Filed as: TR INSURANCE ADVISORS, INC. | 1009 EIGHT AVENUE NE WASECA, MN 56093 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $123 | $18 | $141 | 0.75% |
| EMPLOYEE BENEFIT ADVANTAGES INC3 Filed as: EMPLOYEE BENEFIT ADVANTAGES, INC. | 14740 BOWERS DRIVE NW RAMSEY, MN 55303 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $119 | $0 | $119 | 0.64% |
| MJ INSURANCE3 Filed as: DESIREE WENDELL AND VARIOUS AGENTS | 39050 HARDER PARKWAY NORTH BRANCH, MN 55056 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $60 | $11 | $71 | 0.38% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $65 | $0 | $65 | 0.35% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 100 BLOOMINGTON, MN 55437 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $823 | $0 | $823 | 11.49% |
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 | 129 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 129 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PREFERREDONE INSURANCE COMPANY | 114 | $672K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 79 | $7K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 129 | $41K |
| Short-term disability | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 23 | $19K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 129 | $22K |
| Prescription drug | PREFERREDONE INSURANCE COMPANY | 114 | $656K |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 129 | $57K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 129 | — |
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.