| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JACQUELINE BARTHELEMY3 Filed as: JACQUELINE M BARTHELEMY | 7573 HILLTON ROAD ROYALTON, MN 56373 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | $0 | $7K | 4.92% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK FINANCIAL SERVICES INC | PO BOX 346 AVON, MN 56310 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | $0 | $7K | 4.92% |
| BENEUSA LLC3 | PO BOX 1240 WATERTOWN, MN 55388 | PRINCIPAL LIFE INSURANCE COMPANY | $5K | $4 | $5K | 3.28% |
| JACQUELINE BARTHELEMY3 Filed as: JACQUELINE M BARTHELEMY | 7573 HILTON ROAD ROYALTON, MN 56373 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $9K | $1K | $10K | 12.60% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $1K | $1K | $2K | 2.99% |
| ASHLEY MARIA HOUTMAN3 | 3108 WESTEDGE BLVD MOUND, MN 55364 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $2K | $473 | $2K | 2.59% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $996 | $386 | $1K | 1.67% |
| ANDREW JAMIN GRIMSLEY3 | 1639 GOETTENS WAY SAINT CLOUD, MN 56301 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $806 | $44 | $850 | 1.03% |
| ELIZABETH MARIE LANGEVIN3 | 698 W LARPENTEUR AVE ST. PAUL, MN 55113 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $516 | $182 | $698 | 0.85% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KLH INSURANCE INC | 6505 DEMPSEY AVE SW WAVERLY, MN 55390 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $374 | $114 | $488 | 0.59% |
| JILL R LAMBERT3 | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $330 | $81 | $411 | 0.50% |
| ROBERT SCOTT BRUNER3 | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $187 | $204 | $391 | 0.47% |
| JULIE ANN GUGLIELMO3 | 4935 SHERIDAN AVE N MINNEAPOLIS, MN 55430 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $383 | $0 | $383 | 0.46% |
| JON OLSON3 | 8662 CARRIAGE HILL RD SAVAGE, MN 55378 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $102 | $4 | $106 | 0.13% |
| TYLER HERRINGTON TORBETT3 Filed as: TYLER JAMES JENDRO | 2019 4TH AVE N APT 202 SAUK RAPIDS, MI 56379 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $105 | $0 | $105 | 0.13% |
| MELISSA ARMATIS3 Filed as: MELISSA JEAN WOKASCH | 900 NORTH SHORE DR DETROIT LAKES, MN 56501 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $96 | $0 | $96 | 0.12% |
| BELL INSURANCE SERVICES3 Filed as: BELL INSURANCE SERVICES LLC | PO BOX 1470 FARGO, ND 58107 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $43 | $0 | $43 | 0.05% |
| NATALIE SUZANNE FONVILLE3 | 2415 ZENITH AVE N GOLDEN VALLEY, MN 55422 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $29 | $13 | $42 | 0.05% |
| BLUE SKY BENEFIT SOLUTIONS INC3 Filed as: BLUE SKY BENEFIT SOLUTIIONS INC | 1500 39TH ST. SOUTH SAINT CLOUD, MN 56301 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $29 | $12 | $41 | 0.05% |
| CARRIE S FLATEN3 | 2606 86TH CT W NORTHFIELD, MN 55057 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $8 | $0 | $8 | 0.01% |
| ZACHARY GUSTAFSON3 | 9699 201ST AVE NW ELK RIVER, MN 55330 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $4 | $0 | $4 | 0.00% |
| JACQUELINE BARTHELEMY3 Filed as: JACQUELINE M BARTHELEMY | 7573 HILTON ROAD ROYALTON, MN 56373 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $466 | $50 | $516 | 9.84% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $64 | $47 | $111 | 2.12% |
| ANDREW JAMIN GRIMSLEY3 | 1639 GOETTENS WAY SAINT CLOUD, MN 56301 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $70 | $3 | $73 | 1.39% |
| ASHLEY MARIA HOUTMAN3 | 3108 WESTEDGE BLVD MOUND, MN 55364 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $52 | $14 | $66 | 1.26% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $45 | $14 | $59 | 1.13% |
| JILL R LAMBERT3 | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $14 | $2 | $16 | 0.31% |
| MELISSA ARMATIS3 Filed as: MELISSA JEAN WOKASCH | 900 NORTH SHORE DR DETROIT LAKES, MN 56501 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $15 | $0 | $15 | 0.29% |
| ROBERT SCOTT BRUNER3 | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $6 | $6 | $12 | 0.23% |
| ELIZABETH MARIE LANGEVIN3 | 698 W LARPENTEUR AVE ST PAUL, MN 55113 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $8 | $1 | $9 | 0.17% |
| BELL INSURANCE SERVICES3 Filed as: BELL INSURANCE SERVICES LLC | PO BOX 1470 FARGO, ND 58107 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $6 | $0 | $6 | 0.11% |
| TYLER HERRINGTON TORBETT3 Filed as: TYLER JAMES JENDRO | 2019 4TH AVE N APT 202 SAUK RAPIDS, MN 56379 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $2 | $0 | $2 | 0.04% |
| CARRIE S FLATEN3 | 2606 86TH CT W NORTHFIELD, MN 55057 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| ETHON ISREAL CRUZ3 | 893 SOUTH 2100 WEST OREN, UT 84059 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $2 | $0 | $2 | 0.76% |
| ROSE VILLALON PASQUEL3 | 552 E CARSON ST CARSON, CA 90745 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $1 | $0 | $1 | 0.38% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $1 | $0 | $1 | 0.38% |
| ELIZABETH MARIE LANGEVIN3 | 698 W. LARPENTEUR AVE ST PAUL, MN 55113 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| MEGHAN MOFFATT LUCAS3 Filed as: MEGHAN MOFFATT LUCUS | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| CARRIE S FLATEN3 | 2606 86TH CT W NORTHFIELD, MN 55057 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| JILL R LAMBERT3 | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
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 | 684 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 684 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 684 | $137K |
| Life insurance(4 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 684 | $225K |
| Other(3 contracts) | COLONIAL LIFE & ACCIDENTAL INSURANCE COMPANY | 178 | $88K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 684 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.