| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: BLUE CROSS AND BLUE SHIELD OF MN | PO BOX 64560 ST. PAUL, MN 551640560 | BCBSM, INC. D.B.A BLUE CROSS BLUESHIELD OF MN | $38K | — | $38K | 11.10% |
| RUSSELL CLOUSING0 | 501 BOYLSTON ST STE 300 BOSTON, MA 021163725 | METROPOLITAN LIFE INSURANCE COMPANY | $6 | — | $6 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WILSON-MCSHANE CORPORATION EIN 41-0956552 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $493K |
| BLUE CROSS BLUE SHIELD OF MN EIN 41-0984460 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $252K |
| PRIME THERAPEUTICS EIN 26-0076803 NONE | Direct payment from the plan; Other services; Claims processing Service code 12 | — | $123K |
| THE SEGAL COMPANY EIN 13-1975125 NONE | Insurance agents and brokers; Consulting (general); Direct payment from the plan Service code 16 | — | $80K |
| DELTA DENTAL EIN 41-1905554 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $50K |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $28K |
| LONGFELLOW INVESTMENT CO EIN 04-2933956 NONE | Investment management fees paid directly by plan; Direct payment from the plan; Investment management Service code 28 | — | $22K |
| T.E.A.M. EIN 81-4050818 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $22K |
| MCGRANN SHEA CARNIVAL STRAUGHN LAMB EIN 41-1654544 NONE | Legal; Direct payment from the plan Service code 29 | — | $20K |
| MEKETA INVESTMENT GROUP EIN 04-2659023 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $15K |
| UNION BANK AND TRUST EIN 41-1267434 NONE | Direct payment from the plan Service code 50 | — | $10K |
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 | 1,501 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 487 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,988 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BCBSM, INC. D.B.A BLUE CROSS AND BLUESHIELD OF MINNESOTA | 525 | $1.2M |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 1,411 | $176K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 526 | $535K |
| Stop-loss / reinsurancereinsurance | BCBSM, INC. D.B.A BLUE CROSS BLUESHIELD OF MN | 1,800 | $340K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 1,411 | $176K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,800 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.