| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE BLOOMINGTON, MN 55437 | MEDICA INSURANCE COMPANY | $119K | $7K | $127K | 3.18% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | PRINCIPAL LIFE INSURANCE COMPANY | $77K | $27K | $104K | 16.03% |
| TIM F. VOIT4 | 787 MEADOW LANE SAINT PAUL, MN 55125 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $1K | $0 | $1K | 9.34% |
| CHARLES A WALTERS4 Filed as: CHARLES A. WALTERS | 13241 WEST GOLDEN PUMA TRAIL PEORIA, AZ 85383 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $45 | $0 | $45 | 0.41% |
| LAURA E SELKEN4 Filed as: LAURA E. SELKEN | 21355 FOXTAIL LANE ROGERS, MN 55374 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $42 | $0 | $42 | 0.38% |
| ANTHONY SCHILLER4 | 24549 COUNTY 4 PARK RAPIDS, MN 56470 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $27 | $0 | $27 | 0.24% |
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 | 281 | 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) | 281 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MEDICA INSURANCE COMPANY | 474 | $4.0M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 582 | $647K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 582 | $647K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 582 | $647K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 582 | $647K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 582 | $647K |
| Prescription drug | MEDICA INSURANCE COMPANY | 474 | $4.0M |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 582 | $658K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 582 | — |
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.