| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHRISTOPHER RYAN CASEY3 | 1700 W 82ND ST STE 160 BLOOMINGTON, MN 554311534 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 7.61% |
| HYATT NORMAN HARPER3 | 10417 EXCELSIOR BLVD STE 1 HOPKINS, MN 55343 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 5.04% |
| HYATT NORMAN HARPER3 | 10417 EXCELSIOR BLVD STE 1 HOPKINS, MN 55343 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $316 | — | $316 | 5.02% |
| CHRISTOPHER RYAN CASEY3 | 1700 W 82ND ST STE 160 BLOOMINGTON, MN 554311534 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $314 | — | $314 | 4.99% |
| UNITED OF OMAHA LIFE INSURANCE CO5 | MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | — |
| HYATT NORMAN HARPER3 | 10417 EXCELSIOR BLVD STE 1 HOPKINS, MN 55343 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $95 | — | $95 | — |
| CHRISTOPHER RYAN CASEY3 | 1700 W 82ND ST STE 160 BLOOMINGTON, MN 55431 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $92 | — | $92 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRIME THERAPEUTICS PHARMACY BENEFIT MANAGER | Other fees Service code 99 | 1305 CORPORATE CENTER DRIVE EAGAN, MN 55121 | $0 |
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 | 124 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 132 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 152 | $707K |
| Dental | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 152 | $707K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $6K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 105 | $0 |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 98 | $26K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 152 | $707K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 152 | — |
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.