| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 400 BLOOMINGTON, MN 55437 | MEDICA INSURANCE COMPANY | $44K | $1K | $45K | 3.07% |
| USI INSURANCE SERVICES LLC3 | 1020 36TH STREET SW FARGO, ND 58103 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $15K | $0 | $15K | 14.62% |
| USI INSURANCE SERVICES LLC3 | PO BOX 601478 CHARLOTTE, NC 28260 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $476 | $476 | 0.46% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $85 | $85 | 0.08% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DRIVE, SUITE 400 VALHALLA, NY 10595 | DELTA DENTAL OF MINNESOTA | $8K | $0 | $8K | 9.13% |
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 | 248 | 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) | 248 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MEDICA INSURANCE COMPANY | 208 | $1.5M |
| Dental | DELTA DENTAL OF MINNESOTA | 232 | $92K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 248 | $104K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 248 | $104K |
| Prescription drug | MEDICA INSURANCE COMPANY | 208 | $1.5M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 248 | $104K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 248 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.