| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SEVENHILLS CLEVELAND LLC3 | 7900 INTERNATIONAL DRIVE SUITE 900 BLOOMINGTON, MN 55425 | BCBSMN, INC DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | $44K | — | $44K | 9.46% |
| HORIZON BENEFITS LLC3 Filed as: HORIZON AGENCY | 6500 CITY WEST PKWY # 100 EDEN PRAIRIE, MN 55344 | SUN LIFE ASSURANCE COMPANY OF CANADA | $10K | $3K | $13K | 7.23% |
| SEVENHILLS CLEVELAND LLC3 | 7900 INTERNATIONAL DRIVE SUITE 900 BLOOMINGTON, MN 55425 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | — | $2K | 1.06% |
| HORIZON BENEFITS LLC3 Filed as: HORIZON AGENCY | 6500 CITY WEST PKWY # 100 EDEN PRAIRIE, MN 55344 | STANDARD INSURANCE COMPANY | $5K | — | $5K | 12.60% |
| SEVENHILLS CLEVELAND LLC3 | 7900 INTERNATIONAL DRIVE SUITE 900 BLOOMINGTON, MN 55425 | STANDARD INSURANCE COMPANY | $1K | — | $1K | 2.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BCBSMN, INC DBA BLUE CROSS AND BLUE EIN 41-0984460 INSURANCE CARRIER | Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | 3400 YANKEE DR EAGAN, MN 55121 | $36K |
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 | 166 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 166 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BCBSMN, INC DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA | 373 | $463K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 166 | $186K |
| Life insurance | STANDARD INSURANCE COMPANY | 164 | $42K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 166 | $186K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 166 | $186K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 166 | $186K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 373 | — |
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.