| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: BLUECROSS AND BLUESHIELD OF MN | PO BOX 64560 ST. PAUL, MN 55164 | BLUE CROSS BLUE SHIELD OF MINNESOTA | $25K | — | $25K | 10.06% |
| HAYES BENEFITS GROUP LLC3 | 394 S. LAKE AVENUE #515 DULUTH, MN 55802 | BLUE CROSS BLUE SHIELD OF MINNESOTA | $25K | — | $25K | 9.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WILSON-MCSHANE CORPORATION EIN 41-0956552 NONE | Contract Administrator; Accounting (including auditing) Service code 10 | — | $598K |
| BLUE CROSS BLUE SHIELD OF MN EIN 41-0984460 NONE | Contract Administrator; Other fees; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $312K |
| DDMN ASO LLC EIN 41-1905554 NONE | Claims processing Service code 12 | — | $54K |
| BENEFIT PLAN ADMINISTRATION OF WI EIN 39-1400101 NONE | Actuarial Service code 11 | — | $47K |
| PRIME THERAPEUTICS EIN 26-0076803 NONE | Other fees; Other services; Float revenue; Claims processing Service code 12 | — | $44K |
| T.E.A.M., LLC EIN 81-4050818 NONE | Claims processing Service code 12 | — | $38K |
| KUTAK ROCK, LLP EIN 47-0597598 NONE | Legal Service code 29 | — | $26K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Accounting (including auditing) Service code 10 | — | $20K |
| GLOBALCARE EIN 31-1407689 NONE | Claims processing Service code 12 | — | $11K |
| DIMEO SCHNEIDER & ASSOCIATES EIN 36-4001764 NONE | Investment advisory (plan) Service code 27 | — | $7K |
| HONSA-BINDER PRINTING INC NONE | Copying and duplicating Service code 36 | 320 SPRUCE STREET ST. PAUL, MN 55101 | $6K |
| ST. CROIX PRESS, INC. EIN 39-1151669 NONE | Copying and duplicating Service code 36 | — | $5K |
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 | 1,902 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 110 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,012 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MINNESOTA | 171 | $310K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,967 | $79K |
| Prescription drug(2 contracts) | BLUE CROSS BLUE SHIELD OF MINNESOTA | 95 | $200K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MINNESOTA | 1,978 | $250K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,967 | $79K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,978 | — |
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.