| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC. | 80 SOUTH EIGHTH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | BLUE CROSS AND BLUE SHIELD OF MINNESOTA AND BLUE PLUS | $25K | $0 | $25K | 2.21% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | BLUE CROSS AND BLUE SHIELD OF MINNESOTA AND BLUE PLUS | $19K | $0 | $19K | 1.69% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC. | 80 SOUTH EIGHTH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | DELTA DENTAL OF MINNESOTA | $6K | $0 | $6K | 5.90% |
| USI INSURANCE SERVICES LLC3 | 18115 59TH AVENUE NORTH PLYMOUTH, MN 55466 | DELTA DENTAL OF MINNESOTA | $3K | $0 | $3K | 3.40% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC. | 80 SOUTH EIGHTH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $867 | $8K | 8.26% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 400 EDEN PRAIRIE, MN 55347 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $530 | $5K | 5.61% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 4.84% |
| BRIDGET ZUNIGA3 Filed as: BRIDGET AUSMAN | 1086 HOWARD STREET SAN FRANCISCO, CA 94103 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $948 | $0 | $948 | 0.99% |
| MACARIO CORPORATION3 | 25900 AUTUMN WAY ROGERS, MN 55374 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $493 | $0 | $493 | 0.51% |
| NATIONAL ENROLLMENT PARTNERS LLC3 Filed as: NATIONAL ENROLLMENT PARTNERS, LLC | 25900 AUTUMN WAY ROGERS, MN 55374 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $456 | $456 | 0.48% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $0 | $7K | 22.56% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC. | 80 SOUTH EIGHTH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $248 | $4K | 11.36% |
| BRIDGET ZUNIGA3 Filed as: BRIDGET AUSMAN | 1086 HOWARD STREET SAN FRANCISCO, CA 94103 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $753 | $0 | $753 | 2.27% |
| NATIONAL ENROLLMENT PARTNERS LLC3 Filed as: NATIONAL ENROLLMENT PARTNERS, LLC | 25900 AUTUMN WAY ROGERS, MN 55374 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $597 | $597 | 1.80% |
| MACARIO CORPORATION3 | 25900 AUTUMN WAY ROGERS, MN 55374 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $270 | $0 | $270 | 0.81% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 400 EDEN PRAIRIE, MN 55347 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $16 | $3 | $19 | 0.06% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 400 EDEN PRAIRIE, MN 55347 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $786 | $0 | $786 | 5.74% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC. | 80 SOUTH EIGHTH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $453 | $0 | $453 | 3.31% |
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 | 215 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 220 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF MINNESOTA AND BLUE PLUS | 173 | $1.1M |
| Dental | DELTA DENTAL OF MINNESOTA | 243 | $98K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 100 | $14K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 156 | $129K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 91 | $33K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 156 | $96K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF MINNESOTA AND BLUE PLUS | 173 | $1.1M |
| Other(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF MINNESOTA AND BLUE PLUS | 173 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 243 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.