| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NORTH RISK PARTNERS LLC3 | — | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (BCBSND) | $19K | — | $19K | 1.00% |
| NORTH RISK PARTNERS LLC3 | PO BOX 10 THIEF RIVER FALLS, MN 56701 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 19.11% |
| HAJOSTEK, PATRICIA A3 | 1508 ALEXANDER AVENUE CROOKSTON, MN 56716 | STARMOUNT LIFE INSURANCE COMPANY | $2K | — | $2K | 13.38% |
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVE CROOKSTON, MN 56716 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $820 | — | $820 | 8.92% |
| DEACON CHARLES KAVANAUGH3 | 6336 HILL CREEK DR THE COLONY, TX 75056 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $100 | $10 | $110 | 1.20% |
| NATIONAL ENROLLMENT PARTNERS LLC3 | C/O NATL ENROLLMENT PARTNERS CRANSTON, RI 02920 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $65 | $41 | $106 | 1.15% |
| ROBERT SCOTT BRUNER3 | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $38 | $29 | $67 | 0.73% |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.18% |
| BLUE SKY BENEFIT SOLUTIONS INC3 | PO BOX 2091 QUARTZSITE, AZ 85346 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.13% |
| BLUE SKY BENEFIT SOLUTIONS INC3 | 4010 CLEARWATER RD APT 202 SAINT CLOUD, MN 56301 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.13% |
| BRENDA LEE CANNING3 | 4227 THRU ST SAINT CLOUD, MN 56303 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.11% |
| NATALIE SUZANNE FONVILLE3 | 2415 ZENITH AVE N GOLDEN VALLEY, MN 55422 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.08% |
| CARRIE S FLATEN3 | 27028 86TH CT W NORTH FIELD, MN 55057 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.05% |
| TIMOTHY STERLING3 | 1314 PLUMWOOD CT WAITE PARK, MN 56387 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.03% |
| NICOLE TOWNSEND VEDDER3 | 6548 WILDEMEADE PL TALLAHASSEE, FL 32309 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.03% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.02% |
| ELIZABETH MARIE LANGEVIN3 | 51685 BELLE ISLE DR RUSH CITY, MN 55069 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.02% |
| GRUBS INSURANCE3 | 525 TAYLOR RD MONTICELLO, FL 32344 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| DAVID J MCCLELLAN3 Filed as: DAVID B MERKHOFER | 2704 SETTER PL TALLAHASSEE, FL 32303 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| JOEY MIGUES3 Filed as: JOEY GRUBBS BENEFITS LLC | 525 TAYLOR RD MONTICELLO, FL 32344 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVE CROOKSTON, MN 56716 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $221 | — | $221 | 11.62% |
| DEACON CHARLES KAVANAUGH3 | 6336 HILL CREEK DR THE COLONY, TX 75056 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $31 | $3 | $34 | 1.79% |
| NATIONAL ENROLLMENT PARTNERS LLC3 | C/O NATL ENROLLMENT PARTNERS CRANSTON, RI 02920 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $18 | $14 | $32 | 1.68% |
| ROBERT SCOTT BRUNER3 | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $15 | $10 | $25 | 1.31% |
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVE CROOKSTON, MN 56716 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $202 | — | $202 | 20.12% |
| NATIONAL ENROLLMENT PARTNERS LLC3 | C/O NATL ENROLLMENT PARTNERS CRANSTON, RI 02920 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $15 | $14 | $29 | 2.89% |
| CHARLES DEACON KAVANAUGH3 | 6336 HILL CREEK DR THE COLONY, TX 75056 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $24 | $3 | $27 | 2.69% |
| ROBERT SCOTT BRUNER3 | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $10 | $10 | $20 | 1.99% |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.10% |
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVE CROOKSTON, MN 56716 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $36 | — | $36 | 6.94% |
| DEACON CHARLES KAVANAUGH3 | 6336 HILL CREEK DR THE COLONY, TX 75056 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6 | $0 | $6 | 1.16% |
| NATIONAL ENROLLMENT PARTNERS LLC3 Filed as: NATIONAL ENROLLMENT PARTNERS, LLC | C/O NATL ENROLLMENT PARTNERS CRANSTON, RI 02920 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $2 | $5 | 0.96% |
| ROBERT SCOTT BRUNER3 | 24620 E. CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $1 | $4 | 0.77% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| STRATACOR EIN 41-1852523 BENEFIT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $9K |
| PATRICIA A HAJOTEK | Insurance agents and brokers Service code 22 | — | $3K |
| PATRICIA A HAJOSTEK AGENT/AGENCY | Insurance agents and brokers Service code 22 | 1508 ALEXANDER AVENUE CROOKSTON, MN 56716 | $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 | 153 | 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) | 153 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (BCBSND) | 228 | $1.9M |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 90 | $14K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 140 | $33K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 140 | $33K |
| Other(5 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 140 | $46K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 228 | — |
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.