| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S 8TH ST MINNEAPOLIS, MN 55402 | SUN LIFE ASSURANCE COMPANY OF CANADA | $41K | — | $41K | 9.22% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S 8TH STREET MINNEAPOLIS, MN 55402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12K | $653 | $12K | 10.58% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $2K | $6K | 5.20% |
| KAREN BOHLER3 | 12810 PRIMROSE LANE EDEN PRAIRIE, MN 55344 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $489 | $2K | 1.92% |
| DAVID HAMPTON3 | 4910 W ARLINGTON PARK BLVD FT WAYNE, IN 46835 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 1.73% |
| ELIZABETH MARIE LANGEVIN3 | 698 W LARPENTEUR AVE ST PAUL, MN 55113 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $225 | $1K | 1.25% |
| ROSA SHALA3 | 2829 SE 38TH STREET OCALA, FL 34480 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $432 | — | $432 | 0.37% |
| EDWARD D SOMMER3 Filed as: EDWARD CHRIS ROSENLUND | 8672 MEADOWVALE DRIVE EDEN PRAIRIE, MN 55347 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $421 | — | $421 | 0.36% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $335 | $80 | $415 | 0.36% |
| JOHN W COURT3 | 3201-B SETLLHORN ROAD FORT WAYNE, IN 46815 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $118 | $100 | $218 | 0.19% |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $123 | $91 | $214 | 0.19% |
| DANA MARIE MOWATT3 | 23701 S WESTERN AVE #112 TORRANCE, CA 90501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $129 | $34 | $163 | 0.14% |
| JILL R LAMBERT3 | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $155 | $2 | $157 | 0.14% |
| AARON VANPELT INC3 Filed as: AARON VANPELT INC. | 9619 SPRUCE LANE FISHERS, IN 46038 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $131 | $19 | $150 | 0.13% |
| LAURA B WETT3 | 8496 100TH ST E NORTHFIELD, MN 55057 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $103 | $6 | $109 | 0.09% |
| CLARICE R MIMS3 | 172-90 HIGHLAND AVENUE JAMAICA ESTATES, NY 11432 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $72 | $23 | $95 | 0.08% |
| COACH CONCEPTS INC3 Filed as: COACH CONCEPTS INC. | 9500 KOGER BLVD. ST. PETERSBURG, FL 33702 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $63 | $12 | $75 | 0.07% |
| JILL R LAMBERT3 Filed as: JILL DICE-MALGIER | 17 MIDBRIDGE DRIVE MEDFORD, NJ 08055 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $56 | — | $56 | 0.05% |
| TWILA MORRIS3 | 23 BLUE JAY DRIVE CLEMENTON, NJ 08021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $55 | — | $55 | 0.05% |
| BRAD BIEL3 | 2 GOLD ST NEW YORK, NY 10038 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $38 | $43 | 0.04% |
| JACKIE LEE KELLER3 | 7622 SERGI CANYON DRIVE INDIANAPOLIS, IN 46217 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $7 | $33 | 0.03% |
| DAVID J MCCLELLAN3 Filed as: DAVID E WYATT | 1011 N 49TH AVE OMAHA, NE 68132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | $4 | $22 | 0.02% |
| DAWN RENEE MORGAN3 | 6413 DUNMOOR DR PLANO, TX 75093 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.01% |
| SAMANTHA L GRIMSLEY3 Filed as: SAMANTHA L. GRIMSLEY | 111 RAMBLING CREEK DRIVE ST. MICHAELS, MN 55376 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.01% |
| ALLYN INCORPORATED3 | 3013 BROOKFIELD LANE CLEARWATER, FL 33761 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | $1 | $10 | 0.01% |
| HECTOR MARTINEZ3 | 843 MALTMAN AVE LOS ANGELES, CA 90026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $1 | $9 | 0.01% |
| ANTIONE T TURNER3 | 1929 B GATES AVE REDONDO BEACH, CA 90278 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $1 | $9 | 0.01% |
| EVELYN GARCIA3 | 1562 1ST AVE NEW YORK, NY 10028 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $3 | $8 | 0.01% |
| SAMUEL TADLOCK3 | 3713 LYNWOOD DR HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| RICHARD MARK DECKARD3 | 4619 PIER CT SOUTH BEND, IN 46628 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.00% |
| TERESA MARIE CHRISTMAN3 | 4619 PIER CT SOUTH BEND, IN 46628 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.00% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R & B ENROLLMENT SERVICES INC. | P.O. BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.00% |
| MICHAEL J PERRI3 | 775 ROUTE 70 EAST MARLTON, NJ 08053 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.00% |
| MARK J ROBISON3 | 1255 KIENAS ROAD KALISPELL, MT 59901 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $1 | $5 | 0.00% |
| ROBERT E ELLIS3 | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.00% |
| SUSAN MAE DANIEL3 Filed as: SUSAN G BOXRUD | 1804 MICHIGAN DRIVE NORTHFIELD, MN 55057 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.00% |
| DENNIS W BYERS3 | 8739 PROMONTORY RD INDIANAPOLIS, IN 46236 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS INC. | 806 NW 79TH STREET VANCOUVER, WA 98665 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.00% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 S 8TH STREET MINNEAPOLIS, MN 55402 | VISION SERVICE PLAN | $5K | — | $5K | 10.00% |
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 | 693 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 694 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 360 | $54K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 694 | $446K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 694 | $446K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 694 | $446K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 694 | $561K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 694 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.