| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK FINANCIAL SERVICES INC | P O BOX 346 AVON, MN 56310 | MEDICA INSURANCE COMPANY | $62K | — | $62K | 2.17% |
| ENROLLEASE3 Filed as: THE KNW GROUP LLC | 505 HWY 169 N STE 1100 PLYMOUTH, MN 55441 | MEDICA INSURANCE COMPANY | $23K | — | $23K | 0.81% |
| JACKI M BARTHELEMY3 | 7573 HILLTON RD ROYALTON, MN 56373 | PRINCIPAL LIFE INSURANCE COMPANY | $10K | — | $10K | 4.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK FINANCIAL SERVICES INC | P O BOX 346 AVON, MN 56310 | PRINCIPAL LIFE INSURANCE COMPANY | $10K | — | $10K | 4.67% |
| BENEUSA LLC3 | 261 SCHOOL AVE STE 350 EXCELSIOR, MN 55331 | PRINCIPAL LIFE INSURANCE COMPANY | $7K | — | $7K | 3.11% |
| JACQUELINE BARTHELEMY3 | 7573 HILLTON RD ROYALTON, MN 56373 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $21K | $5K | $26K | 19.51% |
| ASHLEY MARIA HOUTMAN3 | 5447 BREEZY RD MOUND, MN 55364 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $2K | $7K | 5.34% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $2K | $5K | 3.77% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $1K | $3K | 2.41% |
| ANDREW JAMIN GRIMSLEY3 | 1639 GOETTENS WAY SAINT CLOUD, MN 56301 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $14 | $2K | 1.56% |
| JILL R LAMBERT3 Filed as: JILL LAMBERT | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $722 | $334 | $1K | 0.80% |
| ROERT SCOTT BRUNER3 | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $399 | $509 | $908 | 0.68% |
| ELIZABETH MARIE LANGEVIN3 | 698 W LARPENTEUR AVE ST PAUL, MN 55113 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $339 | $64 | $403 | 0.30% |
| MELISSA ARMATIS3 Filed as: MELISSA JEAN WOKASCH | 12549 STILKE LAKE RD FRAZEE, MN 56544 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $102 | — | $102 | 0.08% |
| TYLER HERRINGTON TORBETT3 Filed as: TYLER JAMES JENDRO | 2019 4TH AVE N APT 202 SAUK RAPIDS, MN 56379 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $93 | — | $93 | 0.07% |
| JULIE ANN GUGLIELMO | 4935 SHERIDAN AVE N MINNEAPOLIS, MN 55430 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $64 | — | $64 | 0.05% |
| BELL INSURANCE SERVICES3 Filed as: BELL INSURANCE SERVICES LLC | P O BOX 1470 FARGO, ND 58107 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $42 | — | $42 | 0.03% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: KLH INSURANCE INC | 886 POPLAR LN WATERTOWN, MN 55388 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $1 | $21 | 0.02% |
| NATALIE SUZANNE FONVILLE3 | 2415 ZENITH AVE N GOLDEN VALLEY, MN 55422 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | $4 | $9 | 0.01% |
| CARRIE S FLATEN3 | 2606 86TH CT W NORTHFIELD, MN 55057 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.01% |
| PATRICK M MCGOWAN3 | 4401 PARK GLEN RD MINNEAPOLIS, MN 55416 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.00% |
| BLUE SKY BENEFIT SOLUTIONS INC | 1500 39TH ST S SAINT CLOUD, MN 56301 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.00% |
| EMPLOYEE BENEFIT ADVANTAGES INC3 | 14740 BOWERS DR NW RAMSEY, MN 55303 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| ELTHON ISRAEL CRUZ3 | 893 SOUTH 2100 WEST OREN, UT 84059 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| JACKI M BARTHELEMY3 | 7573 HILLTON RD ROYALTON, MN 56373 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 5.41% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK FINANCIAL SERVICES INC | 110 AVON AVE N AVON, MN 56310 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 5.41% |
| BENEUSA LLC3 | P O BOX 1240 WATERTOWN, MN 55388 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $421 | — | $421 | 2.16% |
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 | 755 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 758 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MEDICA INSURANCE COMPANY | 478 | $2.9M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 910 | $213K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 409 | $19K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 910 | $346K |
| Other | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 286 | $133K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 910 | — |
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.
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.