| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS BENEFIT GROUP LLC | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | BCBSM, INC. D.B.A. BLUE CROSS AND BLUE SHIELD OF MINNESOTA | — | $10K | $10K | 28.49% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | PO BOX 1414 NCB 88 MINNEAPOLIS, MN 55480 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | — | $177 | $177 | 1.55% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| JOHN HANCOCK LIFE INSURANCE CO - VT EIN 03-0367897 NONE | Direct payment from the plan; Other insurance fees and expenses; Insurance services Service code 23 | — | $320K |
| STATE STREET GLOBAL ADVISORS NONE | Investment management; Direct payment from the plan Service code 28 | 1 LINCOLN STREET BOSTON, MA 02111 | $274K |
| STATE STREET BANK & TRUST CO. EIN 04-1867445 NONE | Trustee (bank, trust company, or similar financial institution); Custodial (securities); Direct payment from the plan; Trustee (directed) Service code 19 | — | $31K |
| ASHFORD CAPITAL MANAGEMENT, INC. EIN 51-0243208 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $30K |
| CROWE HORWATH LLP EIN 35-0921680 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $24K |
| ERNST & YOUNG LLP EIN 34-6565596 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $22K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 982 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 982 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BCBSM, INC. D.B.A. BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 982 | $60K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 192 | $11K |
| Stop-loss / reinsurancereinsurance | BCBSM, INC. D.B.A. BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 982 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 982 | — |
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.