| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | BLUE CROSS AND BLUE SHIELD OF MN | $22K | — | $22K | 11.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WILSON-MCSHANE CORPORATION EIN 41-0956552 NONE | Accounting (including auditing); Contract Administrator Service code 10 | — | $543K |
| BLUE CROSS BLUE SHIELD OF MN EIN 41-1427596 NONE | Claims processing Service code 12 | — | $289K |
| BENEFIT PLAN ADMINISTRATION OF WI EIN 39-1401001 NONE | Actuarial Service code 11 | — | $47K |
| DDMN ASO, LLC EIN 41-1905554 NONE | Claims processing Service code 12 | — | $45K |
| ANDERSON, HELGEN, DAVIS & CEFALU EIN 26-3644998 NONE | Legal Service code 29 | — | $39K |
| T.E.A.M., LLC EIN 83-0469948 NONE | Claims processing Service code 12 | — | $38K |
| ENVISION PHARMACEUTICAL SERVICES EIN 90-1011712 NONE | Claims processing Service code 12 | — | $38K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Accounting (including auditing) Service code 10 | — | $17K |
| ANDREW & BRANSKY EIN 41-1502219 NONE | Legal Service code 29 | — | $15K |
| JB INVESTMENT MANAGEMENT, LLC EIN 61-1550321 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $9K |
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 | 1,723 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 169 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,892 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF MN | 168 | $386K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF MN | 169 | $166K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS AND BLUE SHIELD OF MN | 1,712 | $200K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,712 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.