| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 80 SOUTH 8TH STREET STE 700 MINNEAPOLIS, MN 55402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | $0 | $12K | 20.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN&BROWN INSURANCE AGENCY OF VA | 11220 ASSET LOOP STE 304 MANASSAS, VA 20109 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $512 | $512 | 0.86% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 80 SOUTH 8TH STREET STE 700 MINNEAPOLIS, MN 55402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | — | $9K | 20.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN&BROWN INSURANCE AGENCY OF VA | 11220 ASSET LOOP SUITE 304 MANASSAS, VA 20109 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $399 | $399 | 0.91% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 80 SOUTH 8TH STREET STE 700 MINNEAPOLIS, MN 55402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 20.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN&BROWN INSURANCE AGENCY OF VA | 11220 ASSET LOOP STE 304 MANASSAS, VA 20109 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $275 | $275 | 0.85% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES, INC | 80 SOUTH 8TH STREET #700 MINNEAPOLIS, MN 55402 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $3K | — | $3K | 9.95% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES | 80 SOUTH 8TH STREET STE 700 MINNEAPOLIS, MN 55402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $0 | $1K | 20.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN&BROWN INSURANCE AGENCY OF VA | 11220 ASSET LOOP SUITE 304 MANASSAS, VA 20109 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $31 | $31 | 0.52% |
| ALAN R. JESSEN4 Filed as: ALAN R JESSEN | 1308 W 18TH ST CEDAR FALLS, IA 50613 | PRE-PAID LEGAL SERVICES DBA LEGALSHIELD | $340 | — | $340 | 6.88% |
No Schedule C service providers reported on this filing.
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 | 244 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 244 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 334 | $27K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 244 | $44K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 244 | $60K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 244 | $32K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 147 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 334 | — |
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.