| 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 | — | $3K | $3K | 11.83% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | PO BOX 1414 NCB 88 MINNEAPOLIS, MN 55480 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | — | $157 | $157 | 1.93% |
| 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 | — | $307K |
| STATE STREET GLOBAL ADVISORS NONE | Investment management; Direct payment from the plan Service code 28 | 1 LINCOLN STREET BOSTON, MA 02111 | $278K |
| STATE STREET BANK & TRUST CO. EIN 04-1867445 NONE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan; Custodial (securities); Trustee (directed) Service code 19 | — | $55K |
| 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 | — | $27K |
| TOWERS WATSON EIN 23-1159360 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $18K |
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 | 924 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 924 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 924 | $63K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 179 | $8K |
| Stop-loss / reinsurancereinsurance | BCBSM, INC. D.B.A. BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 924 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 924 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.