| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHNSON INSURANCE SERVICES LLC3 Filed as: JOHNSON INSURANCE SERVICES, LLC | 1103 HUNTER DRIVE, SUITE 100 MOUNT PLEASANT, WI 53406 | PRINCIPAL LIFE INSURANCE COMPANY | $33K | $16K | $50K | 7.90% |
| LOCKTON COMPANIES, LLC3 | 5500 WAYZATA BOULEVARD, SUITE 510 MINNEAPOLIS, MN 55416 | PRINCIPAL LIFE INSURANCE COMPANY | $30K | $0 | $30K | 4.72% |
| MARSHBERRY CONNECT PLATFORM LLC3 Filed as: MARSHBERRY CONNECT PLATFORM, LLC | PO BOX 72560 CLEVELAND, OH 44192 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $5K | $5K | 0.82% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $3K | $297 | $4K | 1.32% |
| LOCKTON COMPANIES, LLC3 | 5500 WAYZATA BOULEVARD, SUITE 510 MINNEAPOLIS, MN 55416 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $2K | $0 | $2K | 0.79% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $16K | $4K | $20K | 9.10% |
| MICHELLE J HALLER3 Filed as: MICHELLE J. HALLER | 913 HUNTINGTON WAY JORDAN, MN 55353 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $10K | $7K | $18K | 7.93% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $4K | $10K | 4.54% |
| MJ INSURANCE3 Filed as: CLARICE R. MIMS AND VARIOUS AGENTS | 17290 HIGHLAND AVENUE, APARTMENT 2B JAMAICA, NY 11432 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $1K | $8K | 3.58% |
| LOCKTON COMPANIES, LLC3 | 5500 WAYZATA BOULEVARD MINNEAPOLIS, MN 55416 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 1.83% |
| ELIZABETH MARIE LANGEVIN3 | 51685 BELLE ISLE DRIVE RUSH CITY, MN 55069 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $117 | $2K | 0.74% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $199 | $2K | 0.74% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11K | $3K | $13K | 10.40% |
| MICHELLE J HALLER3 Filed as: MICHELLE J. HALLER | 913 HUNTINGTON WAY JORDAN, MN 55353 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $5K | $11K | 8.74% |
| MJ INSURANCE3 Filed as: CLARICE R. MIMS AND VARIOUS AGENTS | 17290 HIGHLAND AVENUE, APARTMENT 2B JAMAICA, NY 11432 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $939 | $5K | 3.76% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $2K | $5K | 3.71% |
| LOCKTON COMPANIES, LLC3 | 5500 WAYZATA BOULEVARD MINNEAPOLIS, MN 55416 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 1.59% |
| ELIZABETH MARIE LANGEVIN3 | 51685 BELLE ISLE DRIVE RUSH CITY, MN 55069 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $951 | $75 | $1K | 0.79% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $893 | $126 | $1K | 0.79% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $541 | $2K | 9.28% |
| MICHELLE J HALLER3 Filed as: MICHELLE J. HALLER | 913 HUNTINGTON WAY JORDAN, MN 55353 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $1K | $2K | 8.54% |
| MJ INSURANCE3 Filed as: ELIZABETH FENDER AND VARIOUS AGENTS | 335 SOUTH EMERSON AVENUE INDIANAPOLIS, IN 46219 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $204 | $1K | 4.59% |
| LOCKTON COMPANIES, LLC3 | 5500 WAYZATA BOULEVARD MINNEAPOLIS, MN 55416 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $592 | $0 | $592 | 2.25% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $337 | $252 | $589 | 2.24% |
| ROBERT L. COONEY3 | 3386 SOCIALVILLE FOSTER ROAD MAINVILLE, OH 45039 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $279 | $0 | $279 | 1.06% |
| TR INSURANCE ADVISORS INC3 Filed as: TR INSURANCE ADVISORS, INC. | 1009 8TH AVENUE NE WASECA, MN 56093 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $207 | $24 | $231 | 0.88% |
| MICHELLE J HALLER3 Filed as: MICHELLE J. HALLER | 913 HUNTINGTON WAY JORDAN, MN 55353 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $115 | $68 | $183 | 5.75% |
| LOCKTON COMPANIES, LLC3 | 5500 WAYZATA BOULEVARD MINNEAPOLIS, MN 55416 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $143 | $0 | $143 | 4.50% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $107 | $23 | $130 | 4.09% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $49 | $18 | $67 | 2.11% |
| MJ INSURANCE3 Filed as: JILL R. LAMBERT AND VARIOUS AGENTS | 12741 JEFFERSON STREET NE BLAINE, MN 55434 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $36 | $6 | $42 | 1.32% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $2 | $22 | 0.69% |
| ELIZABETH MARIE LANGEVIN3 | 51685 BELLE ISLE DRIVE RUSH CITY, MN 55069 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $1 | $21 | 0.66% |
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 | 1,600 | 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) | 1,600 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 44 | $281K |
| Life insurance(5 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 1,792 | $1.0M |
| Short-term disability(5 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 1,792 | $1.0M |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 1,792 | $630K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 44 | $281K |
| Other(7 contracts, 4 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 1,792 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,792 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.