| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS BENEFIT GROUP, LLC | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | RELIASTAR LIFE INSURANCE COMPANY | $992 | — | $992 | 1.25% |
| ONYX BENEFIT ADVISORS3 | 23365 LAWRENCE WAY HASTINGS, MN 55033 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $151 | — | $151 | 1.84% |
| ASSUREDPARTNERS3 Filed as: ONYX BENEIFT ADVISORS LLC | 23365 LAWRENCE WAY HASTINGS, MN 55033 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $66 | — | $66 | 0.91% |
| ELSIE M POLT3 | 201 W BURNSVILLE PKWY SUITE 116 BURNSVILLE, MN 55337 | AFLAC | $123 | — | $123 | 3.91% |
| MATTHEW R LORENZ3 | 1021 PROSPECT POINTE RD JORDAN, MN 55342 | AFLAC | $57 | — | $57 | 1.81% |
| THE LUTHER GROUP LLC3 | 3704 NW 74TH ST KANSAS CITY, MO 64151 | AFLAC | $55 | — | $55 | 1.75% |
| DARIN D PAVLISH3 | 7760 FRANCE AVE S 1162 EDINA, MN 55435 | AFLAC | $28 | — | $28 | 0.89% |
| HAROLD D SCHWALM3 Filed as: HAROLD SCHWALM | 6413 BROOK LANE SAVAGE, MN 55378 | AFLAC | $11 | — | $11 | 0.35% |
| TARA M JORDAN3 | 800 LAKESHORE DR TUSCOLA, IL 61953 | AFLAC | $10 | — | $10 | 0.32% |
| CAROL SCHRECK3 Filed as: CAROL H SCHRECK | 4796 SAWGRASS DR W ANN ARBOR, MI 48108 | AFLAC | $10 | — | $10 | 0.32% |
| JOHN PAUL THOMPSON SR3 | 6395 S KEWAUNEE WAY SUITE 425 AURORA, CO 80016 | AFLAC | $8 | — | $8 | 0.25% |
| JEFFREY PAUL GRIFFIN3 Filed as: JEFFREY ALLEN FOWLER | 6008 12TH AVE S MPLS, MN 55417 | AFLAC | $8 | — | $8 | 0.25% |
| BANASH & ASSOCIATES3 | 4811 BEACH BLVD SUITE 107 JACKSONVILLE, FL 32207 | AFLAC | $7 | — | $7 | 0.22% |
| JEREMY FRYE & ASSOCIATES INC3 Filed as: JEREMY FRYE & ASSOCICATES INC | 1508 N CHRUCH RD SUITE B LIBERTY, MO 64068 | AFLAC | $5 | — | $5 | 0.16% |
| CAROL SCHRECK3 | 4796 SAWGRASS DR W ANN ARBOR, MI 48108 | AFLAC | $4 | — | $4 | 0.13% |
| GREG A GOULD3 Filed as: GREG GOULD | 8105 GINGKO WAY DEXTER, MI 48130 | AFLAC | $3 | — | $3 | 0.10% |
| PEGGY SUE LAZER3 | 7914 13TH AVE N CHAMPLIN, MN 55316 | AFLAC | $3 | — | $3 | 0.10% |
| SHELLY LUCKEN3 | 8233 133RD PL SAVAGE, MN 55378 | AFLAC | $3 | — | $3 | 0.10% |
| JESSE A REISCH3 | 1505 S MONTICELLO AVE SIOUX FALLS, SD 57106 | AFLAC | $3 | — | $3 | 0.10% |
| BARRY CAMPBELL3 | 2798 COUNTY ROAD 80 ALGER, OH 45812 | AFLAC | $2 | — | $2 | 0.06% |
| AG AND ASSOCIATES3 Filed as: AG & ASSOCIATES | 2150 ASSOCIATION DR SUITE 150 OKEMOS, MI 48864 | AFLAC | $2 | — | $2 | 0.06% |
| CHRISTOPHER WALLACE HOFF3 Filed as: CHRISTOPHER HOFF PROF LLC | 121 ROCKY POINT CT ACWORTH, GA 30101 | AFLAC | $1 | — | $1 | 0.03% |
| BANYASH & ASSOCIATES INC3 Filed as: BANYASH & ASSOCIATES | 3390 KORI RD SUITE 7 JACKSONVILLE, FL 32257 | AFLAC | $1 | — | $1 | 0.03% |
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 | 480 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 487 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 92 | $8K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 502 | $31K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 732 | $79K |
| Long-term disability | RELIASTAR LIFE INSURANCE COMPANY | 732 | $79K |
| Other(3 contracts, 3 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 732 | $90K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 732 | — |
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.