| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JACKI M BARTHELEMY3 | 7573 HILLTON RD ROYALTON, MN 56373 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | — | $7K | 4.71% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK FINANCIAL SERVICES INC | 110 AVON AVE N P O BOX 346 AVON, MN 56310 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | — | $7K | 4.71% |
| BENEUSA LLC3 | 1851 LAKE DR W STE 350 CHANHASSEN, MN 55317 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | — | $4K | 3.14% |
| JACQUELINE BARTHELEMY3 | 7573 HILLTON RD ROYALTON, MN 56373 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11K | $4K | $15K | 18.54% |
| ASHLEY MARIA BARTHELEMY Filed as: ASHLEY MARIE BARTHELEMY | 4011 BRADDOCK AVE NE BUFFALO, MN 55313 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $502 | $3K | 3.36% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $1K | $3K | 3.32% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $600 | $362 | $962 | 1.19% |
| ELIZABETH MARIE LANGEVIN3 | 698 W LARPENTEUR AVE ST PAUL, MN 55113 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $556 | $205 | $761 | 0.94% |
| NELS COREY JOHNSON3 | 25262 SLOTH ST NW ZIMMERMAN, MN 55398 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $709 | — | $709 | 0.88% |
| ANDREW JAMIN GRIMSLEY3 | 1639 GOETTENS WAY SAINT CLOUD, MN 56301 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $544 | $118 | $662 | 0.82% |
| JILL R LAMBERT3 Filed as: JILL LAMBERT | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $324 | $162 | $486 | 0.60% |
| JEFFREY MICHAEL OURADNIK3 | 4203 PARKWAY DR NISSWA, MN 56468 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $371 | $13 | $384 | 0.48% |
| CURTIS LARSON3 | 11626 YUKON ST NW COON RAPIDS, MN 55433 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $248 | $19 | $267 | 0.33% |
| CARRIE S FLATEN3 | 2606 86TH CT W NORTHFIELD, MN 55057 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $145 | $39 | $184 | 0.23% |
| MICHELLE J HALLER3 Filed as: MICHELLE HALLER | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $81 | $78 | $159 | 0.20% |
| MELISSA ARMATIS3 Filed as: MELISSA JEAN WOKASCH | 12549 STILKE LAKE RD FRAZEE, MN 56544 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $149 | — | $149 | 0.18% |
| TYLER HERRINGTON TORBETT3 Filed as: TYLER JAMES JENDRO | 1401 5TH AVE SE APT 102 LITTLE FALLS, MN 56345 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $116 | — | $116 | 0.14% |
| WARNER AND COMPANY3 | P O BOX 1470 FARGO, ND 58107 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $89 | — | $89 | 0.11% |
| JENNIFER GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $36 | — | $36 | 0.04% |
| PATRICK M MCGOWAN3 | 4401 PARK GLEN RD MINNEAPOLIS, MN 55416 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.02% |
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 | 505 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 505 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 594 | $143K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 594 | $224K |
| Other | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 208 | $81K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 594 | — |
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.