| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVE CROOKSTON, MN 56716 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $5K | — | $5K | 8.71% |
| CBIZ BENEFITS & INSURANCE SERVICES5 | PO BOX 632886 CINCINNATI, OH 45263 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $2K | — | $2K | 3.81% |
| BRENDA LEE CANNING3 | 4227 THRU STREET ST. CLOUD, MN 56303 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $591 | $19 | $610 | 1.02% |
| BLUE SKY BENEFIT SOLUTIONS INC3 | 1500 39TH ST SOUTH ST. CLOUD, MN 56301 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $509 | $16 | $525 | 0.88% |
| MARC A GROVE3 | 25900 AUTUMN WAY RODGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $215 | $299 | $514 | 0.86% |
| CARRIE S FLATEN3 | 2606 86TH CT W NORTHFIELD, MN 55057 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $341 | $29 | $370 | 0.62% |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $191 | $125 | $316 | 0.53% |
| ELIZABETH MARIE LANGEVIN3 | 698 W LARPENTEUR AVE ST PAUL, MN 55113 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $55 | $23 | $78 | 0.13% |
| ROBERT SCOTT BRUNER5 | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $20 | $22 | $42 | 0.07% |
| NATALIE SUZANNE FONVILLE3 | 1600 THOMAS AVE N MINNEAPOLIS, MN 55411 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $19 | $9 | $28 | 0.05% |
| CBIZ BENEFITS & INSURANCE SERVICES5 | PO BOX 632886 CINCINNATI, OH 45263 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| CBIZ BENEFITS & INSURANCE SERVICES5 | PO BOX 632886 CINCINNATI, OH 45263 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 16.80% |
| CBIZ BENEFITS & INSURANCE SERVICES5 | 700 W 47TH ST STE 1100 KANSAS CITY, MO 64112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $432 | $432 | 2.40% |
| CBIZ BENEFITS & INSURANCE SERVICES5 | PO BOX 632886 CINCINNATI, OH 45263 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 14.00% |
| CBIZ BENEFITS & INSURANCE SERVICES5 | 700 W 47TH ST STE 1100 KANSAS CITY, MO 64112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $325 | $325 | 2.00% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 58121 | USABLE LIFE | $345 | — | $345 | 20.02% |
| AZURANCE GROUP3 Filed as: AZURANCE GROUP INC | 4510 13TH AVE SW FARGO, ND 58121 | USABLE LIFE | $54 | — | $54 | 4.52% |
| MARGARET BRYANT3 Filed as: MARGARET PEDERSON-HENDERSON | 3108 26TH AVE S FARGO, ND 58103 | USABLE LIFE | $2 | — | $2 | 0.17% |
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 | 156 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | COLONIAL LIFE & ACCIDENT INSURANCE CO | 71 | $60K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 143 | $24K |
| Life insurance(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE CO | 184 | $94K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE CO | 71 | $73K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 0 | $396K |
| Other(6 contracts, 4 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE CO | 184 | $111K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 184 | — |
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.