| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: HAYS GROUP INC | 80 SOUTH 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | MEDICA INSURANCE COMPANY | — | $500 | $500 | 0.02% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC-MINNESOTA | 80 SOUTH 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | MEDICA INSURANCE COMPANY | — | $500 | $500 | 0.02% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES, INC | 80 SOUTH 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 9.93% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FORMULA TRUST EIN 41-6315030 DENTAL ADMINISTRATOR | Contract Administrator Service code 13 | — | $8K |
| LIFE INSURANCE COMPANY OF NORTH AM. EIN 23-1503749 STD ADMINISTRATOR | Contract Administrator Service code 13 | — | $6K |
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 | 198 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 202 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MEDICA INSURANCE COMPANY | 310 | $2.5M |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 169 | $12K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 344 | $39K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 195 | $15K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 318 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 344 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.