| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | SUITE 700 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 8.19% |
| AXA ASSISTANCE, USA5 Filed as: AXA ASSISTANCE USA | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $57 | $57 | 0.05% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $786 | — | $786 | 2.85% |
| ENROLLEASE3 Filed as: HANRATTY AND ASSOCIATES | 15350 25TH AVE N STE 114 MINNEAPOLIS, MN 55447 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $771 | — | $771 | 2.79% |
| ELIZABETH MARIE LANGEVIN3 | 698 W LARPENTEUR AVE ST. PAUL, MN 55113 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $300 | — | $300 | 1.09% |
| PATRICK M MCGOWAN3 | 4401 PARK GLEN RD MINNEAPOLIS, MN 55416 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $231 | — | $231 | 0.84% |
| TAMMY M DAHLBERG3 | 1009 EIGHTH AVE NE WASECA, MN 56093 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $153 | — | $153 | 0.55% |
| KY YARLING3 | PO BOX 521 HANOVER, IN 47243 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $130 | — | $130 | 0.47% |
| BRYON A BROWDER3 | 791 NW 43RD AVE DES MOINES, IA 50313 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $90 | — | $90 | 0.33% |
| WESLEY DALE GINSBACH3 | 18704 KNOTSON RD NEWELL, SD 57760 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.07% |
| JILL R LAMBERT3 | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.05% |
| TIMOTHY RAY CAUDILL3 | P O BOX 212 PELL LAKE, WI 53157 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.04% |
| VOLUNTARY BENEFIT PLANS LLC3 | 2345 S LYNHURST DRIVE INDIANAPOLIS, IN 46241 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.03% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.02% |
| PETER JOSEPH KONICH3 | 7161 OAK POINT CIRCLE NOBLESVILLE, IN 46062 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| JOSEPH MICHAEL EVANS3 | 4721 BROOKVIEW DRIVE WEST DES MOINES, IA 50265 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| JERRI J GREGORY3 | 791 NW 43RD AVE DES MOINES, IA 50313 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| HAYS COMPANIES, INC.3 Filed as: HAYS BENEFITS GROUP LLC | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY INSURANCE CO. | $3K | — | $3K | 15.68% |
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 | 370 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 371 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY INSURANCE CO. | 310 | $18K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 370 | $120K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 370 | $120K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 370 | $120K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 370 | $147K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 370 | — |
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.