| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UPPER MIDWEST LABOR/MANAGEMENT HEAL4 | 1970 OAKCREST AVE STE 119 ROSEVILLE, MN 551132688 | VISION SERVICE PLAN | $170 | — | $170 | 0.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WILSON-MCSHANE CORPORATION EIN 41-0956552 NONE | Plan Administrator; Claims processing; Contract Administrator Service code 12 | — | $249K |
| BCBSMN, INC. EIN 41-0984460 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing; Other fees Service code 12 | — | $85K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Accounting (including auditing) Service code 10 | — | $17K |
| FOX ROTHSCHILD LLP EIN 23-1404723 NONE | Legal Service code 29 | — | $16K |
| FELHABER LARSON EIN 41-0991071 NONE | Legal Service code 29 | — | $16K |
| DDMN ASO, LLC EIN 41-1905554 NONE | Claims processing; Contract Administrator Service code 12 | — | $13K |
| PRIME THERAPEUTICS EIN 26-0076803 NONE | Claims processing; Other services; Other fees; Float revenue Service code 12 | — | $12K |
| TEAM, INC. EIN 81-4050818 NONE | Claims processing; Contract Administrator Service code 12 | — | $11K |
| UNITED ACTUARIAL SERVICES INC. EIN 35-2156428 NONE | Actuarial Service code 11 | — | $8K |
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 | 534 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 35 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 569 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MINNESOTA | 24 | $50K |
| Vision | VISION SERVICE PLAN | 424 | $52K |
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 435 | $13K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MINNESOTA | 23 | $38K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MINNESOTA | 455 | $376K |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 435 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 455 | — |
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."
No prospect flags tripped on this filing.