| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENE USA LLC3 | 261 SCHOOL AVE SUITE 350 EXCELSIOR, MN 55331 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $507 | — | $507 | 5.00% |
| HORIZON BENEFITS LLC3 Filed as: HORIZON AGENCY INC | — | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $81 | $81 | 0.80% |
| SEVENHILLS CLEVELAND LLC3 | — | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $18 | $18 | 0.18% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FORMULA CORPORATION EIN 41-1559435 NONE | Claims processing; Contract Administrator Service code 12 | — | $78K |
| BLUE CROSS AND BLUE SHIELD EIN 41-0984460 NONE | Other fees; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $35K |
| SUPERIOR BENEFIT ADVISORS LLC EIN 82-3736421 NONE | Insurance services Service code 23 | — | $20K |
| BETTS & HAYES LTD EIN 41-1619880 NONE | Accounting (including auditing) Service code 10 | — | $17K |
| RISK ANALYSIS & MANAGEMENT INC EIN 41-1356548 NONE | Insurance services Service code 23 | — | $10K |
| NYHART COMPANY INCORPORATED EIN 35-0966414 NONE | Actuarial Service code 11 | — | $5K |
| PRIME THERAPEUTICS EIN 26-0076803 NONE | Claims processing Service code 12 | — | $0 |
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 | 110 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 124 | $10K |
| Stop-loss / reinsurancereinsurance | BSBCM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 111 | $461K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 124 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 124 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.