| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HORIZON BENEFITS LLC3 Filed as: HORIZON AGENCY INC | — | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $0 | $3K | $3K | 9.04% |
| BENEUSA LLC3 | 1851 LAKE DRIVE WEST SUITE 350 CHANHASSEN, MN 55317 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BCBSMN, INC EIN 41-0984460 NONE | Contract Administrator; Claims processing; Other fees; Legal; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $517K |
| FORMULA CORPORATION EIN 41-1559435 NONE | Claims processing; Contract Administrator Service code 12 | 2919 EAGANDALE BLVD, SUITE 120 EAGAN, MN 55121 | $472K |
| THOMAS M HUGHES, LTD EIN 26-3097969 NONE | Legal Service code 29 | 2355 FAIRVIEW AVE ROSEVILLE, MN 55113 | $30K |
| BETTS & HAYES, LTD EIN 41-1619880 NONE | Accounting (including auditing) Service code 10 | 801 MEANDER COURT MEDINA, MN 55340 | $25K |
| ALTON JOHNSON NONE | Other fees Service code 99 | 3541 COLFAX AVE S MINNEAPOLIS, MN 55408 | $24K |
| THE SEGAL COMPANY EIN 13-1975125 NONE | Actuarial Service code 11 | 3800 WEST 80TH STREET SUITE 870 BLOOMINGTON, MN 55431 | $22K |
| CLEVELAND-MAHER LLC EIN 27-2039796 NONE | Insurance services Service code 23 | 1650 W 82ND ST SUITE 850 MINNEAPOLIS, MN 55431 | $10K |
| SEVENHILLS CLEVELAND BENEFIT PARTNE EIN 82-3736421 NONE | Insurance services Service code 23 | 7900 INTERNATIONAL DRIVE SUITE 990 BLOOMINGTON, MN 55425 | $10K |
| WELLS FARGO ADVISORS EIN 41-6027254 NONE | Distribution (12b-1) fees; Securities brokerage; Investment advisory (plan) Service code 27 | — | $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 | 1,382 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 39 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,421 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,665 | $36K |
| Stop-loss / reinsurancereinsurance | BCBSM, INC. | 1,445 | $388K |
| Other | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,665 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,665 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.