| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET SUITE 700 MINNEAPOLIS, MN 55402 | BCBSM, INC. D.B.A. BLUE CROSS AND BLUE SHIELD OF MINNESOTA | — | $3K | $3K | 4.63% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| JOHN HANCOCK LIFE & HEALTH INS CO. EIN 03-0367897 NONE | Other insurance fees and expenses; Insurance services; Direct payment from the plan Service code 23 | — | $568K |
| STATE STREET BANK & TRUST CO. EIN 04-1867445 NONE | Trustee (bank, trust company, or similar financial institution); Trustee (directed); Custodial (securities); Direct payment from the plan Service code 19 | — | $46K |
| CROWE LLP EIN 35-0921680 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $35K |
| WINDMARK INVESTMENT PARTNERS INC EIN 20-0929412 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $32K |
| TOWERS WATSON EIN 23-1159360 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $19K |
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 | 722 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 722 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BCBSM, INC. D.B.A. BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 722 | $69K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 163 | $7K |
| Stop-loss / reinsurancereinsurance | BCBSM, INC. D.B.A. BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 722 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 722 | — |
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.