| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NORTH RISK PARTNERS LLC3 | — | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (BCBSND) | $17K | — | $17K | 1.00% |
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVE CROOKSTON, MN 56716 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 15.45% |
| DEACON CHARLES KAVANAUGH3 | 6336 HILL CREEK DR THE COLONY, TX 75056 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $204 | $25 | $229 | 1.54% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $135 | $93 | $228 | 1.53% |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $128 | $89 | $217 | 1.46% |
| MPART BENEFITS INC3 Filed as: MPART BENEFITS INC. | 100 ALBRIGHT LN PROSPER, TX 75078 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $42 | $36 | $78 | 0.52% |
| NATALIE SUZANNE FONVILLE3 | 2415 ZENITH AVE N GOLDEN VALLEY, MN 55422 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $37 | $3 | $40 | 0.27% |
| BLUE SKY BENEFIT SOLUTIONS INC3 | 4010 CLEARWATER RD APT 202 SAINT CLOUD, MN 56301 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.18% |
| BRENDA LEE CANNING3 | 4227 THRU ST SAINT CLOUD, MN 56303 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.17% |
| ROBERT SCOTT BRUNER3 | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7 | $7 | $14 | 0.09% |
| CARRIE S FLATEN3 | 27028 6TH CT W NORTH FIELD, MN 55057 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.07% |
| TIMOTHY STERLING3 | 1314 PLUMWOOD CT WAITE PARK, MN 56387 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.03% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.02% |
| ELIZABETH MARIE LANGEVIN3 | 51685 BELLE ISLE DR RUSH CITY, MN 55069 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.02% |
| NICOLE TOWNSEND VEDDER3 Filed as: NICOLE TOWNSEND VETTER | 6548 WILDEMEADE PL TALLAHASSEE, FL 32309 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.02% |
| JOEY MIGUES3 Filed as: JOEY GRUBBS BENEFITS LLC | 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% |
| HAJOSTEK, PATRICIA A3 | 1508 ALEXANDER AVENUE CROOKSTON, MN 56716 | STARMOUNT LIFE INSURANCE COMPANY | $2K | — | $2K | 12.31% |
| HAJOSTEK, PATRICIA A3 | 1508 ALEXANDER AVENUE CROOKSTON, MN 56716 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $851 | — | $851 | 11.02% |
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVE CROOKSTON, MN 56716 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $91 | — | $91 | 6.28% |
| NATALIE SUZANNE FONVILLE3 | 2415 ZENITH AVE N GOLDEN VALLEY, MN 55422 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.41% |
| BLUE SKY BENEFIT SOLUTIONS INC3 | 4010 CLEARWATER RD APT 202 SAINT CLOUD, MN 56301 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.28% |
| TIMOTHY STERLING3 | 1314 PLUMWOOD CT WAITE PARK, MN 56387 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.28% |
| BRENDA LEE CANNING3 | 4227 THRU ST SAINT CLOUD, MN 56303 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.28% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.21% |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.21% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.14% |
| ELIZABETH MARIE LANGEVIN3 | 51685 BELLE ISLE DR RUSH CITY, MN 55069 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.14% |
| DEACON CHARLES KAVANAUGH3 | 6336 HILL CREEK DR THE COLONY, TX 75056 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.07% |
| MPART BENEFITS INC3 Filed as: MPART BENEFITS INC. | 100 ALBRIGHT LN PROPER, TX 75078 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVE CROOKSTON, MN 56716 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $103 | — | $103 | 30.21% |
| CHARLES DEACON KAVANAUGH3 | 6336 HILL CREEK DR THE COLONY, TX 75056 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $12 | $2 | $14 | 4.11% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6 | $6 | $12 | 3.52% |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6 | $5 | $11 | 3.23% |
| MPART BENEFITS INC3 Filed as: MPART BENEFITS INC. | 100 ALBRIGHT LN PROSPER, TX 75078 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $2 | $5 | 1.47% |
| ROBERT SCOTT BRUNER3 | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $0 | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| STRATACOR EIN 41-1852523 BENEFIT ADMINISTRATOR | Claims processing; Contract Administrator 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 | 142 | 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) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (BCBSND) | 231 | $1.7M |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 79 | $12K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 138 | $8K |
| Other(3 contracts) | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | 27 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 231 | — |
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.