| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEUSA LLC3 | 1851 LAKE DRIVE WEST SUITE 350 CHANHASSEN, MN 55317 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BCBSMN, INC EIN 41-0984460 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Legal; Claims processing; Contract Administrator Service code 12 | — | $569K |
| FORMULA CORPORATION EIN 41-1559435 NONE | Contract Administrator; Claims processing Service code 12 | 2919 EAGANDALE BLVD, SUITE 120 EAGAN, MN 55121 | $452K |
| BETTS & HAYES, LTD EIN 41-1619880 NONE | Accounting (including auditing) Service code 10 | 801 MEANDER COURT MEDINA, MN 55340 | $35K |
| THOMAS M HUGHES, LTD EIN 26-3097969 NONE | Legal Service code 29 | 2355 FAIRVIEW AVE ROSEVILLE, MN 55113 | $31K |
| HORIZON ACTUARIAL SERVICES LLC EIN 26-1370698 NONE | Actuarial Service code 11 | — | $25K |
| ALTON JOHNSON NONE | Other fees Service code 99 | 3541 COLFAX AVE S MINNEAPOLIS, MN 55408 | $24K |
| SEVENHILLS CLEVELAND BENEFIT PARTNE EIN 82-3736421 NONE | Insurance services Service code 23 | 7900 INTERNATIONAL DRIVE SUITE 990 BLOOMINGTON, MN 55425 | $20K |
| ATHOS HEALTH EIN 81-1356345 NONE | Accounting (including auditing) Service code 10 | PO BOX 40294 SAINT PAUL, MN 55104 | $15K |
| KATHRYN HIPP CARLSON EIN 26-3965589 NONE | Legal Service code 29 | — | $7K |
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 | 1,365 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 26 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,391 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,368 | $41K |
| Stop-loss / reinsurancereinsurance | BCBSM, INC. | 1,396 | $390K |
| Other | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,368 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,396 | — |
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.