| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 S 8TH STREET MINNEAPOLIS, MN 55402 | SELECTHEALTH | $48K | $16K | $64K | 2.36% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $9K | — | $9K | 2.54% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | METROPOLITAN LIFE INSURANCE COMPANY | $14K | $2K | $16K | 6.75% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $2K | $13K | 12.00% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $661 | $6K | 17.00% |
| CUSTOM INSURANCE SPECIALISTS INC3 Filed as: CUSTOM INSURANCE SPECIALISTS INC. | 866 E 3200 N KAMAS, UT 84036 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $208 | $2K | 8.00% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $255 | $2K | 5.79% |
| TIM VINCENT INS AGY INC3 Filed as: TIM VINCENT INS. AGCY. INC. | 3489 W. 10305 SOUTH SOUTH JORDAN, UT 84095 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $535 | $164 | $699 | 2.38% |
| JILL WHITE3 | 6510 TAMARA DR. SALT LAKE CITY, UT 84129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $528 | $43 | $571 | 1.94% |
| DESIREE ROBERTSON3 | 5691 S. STONE BLUFFWAY TAYLORSVILLE, UT 84118 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $492 | $3 | $495 | 1.68% |
| ALTON B BARTON3 Filed as: ALTON BARTON | 1911 MAYLIN DR. SALEM, VA 24153 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $243 | $51 | $294 | 1.00% |
| SUSAN MAE DANIEL3 Filed as: SUSAN LEACH | 4419 NE 131ST PL. PORTLAND, OR 97230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $134 | $21 | $155 | 0.53% |
| SHANE MATTHEW SALYERS3 Filed as: SHANE SALYERS | 192 SUMMERFIELD CT. ROANOKE, VA 24019 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $128 | $1 | $129 | 0.44% |
| SAMUEL SWINDELL3 | 2207 GLADE RD. BLACKSBURG, VA 24060 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $105 | $22 | $127 | 0.43% |
| MORETON & COMPANY3 Filed as: FRED A MORETON AND CO | PO BOX 58139 SALT LAKE CITY, UT 84158 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $83 | — | $83 | 0.28% |
| RAYMOND B LINGLE3 Filed as: RAYMOND LINGLE | 192 SUMMERFIELD CT. ROANOKE, VA 24019 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $69 | $11 | $80 | 0.27% |
| CHRISTINE LYNN MORGESTER3 Filed as: CHRISTINE MORGESTER | 9405 NE 100TH WAY VANCOUVER, WA 98662 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $50 | $5 | $55 | 0.19% |
| CHARLES A DUVALL III3 Filed as: CHARLES DUVALL III | 166 PIPPIN ST. ROANOKE, VA 24019 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $34 | $8 | $42 | 0.14% |
| THE BUCKNER COMPANY3 Filed as: THE BUCKNER COMPANY INC. | 6550 MILLROCK DR. SALT LAKE CITY, UT 84121 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $29 | — | $29 | 0.10% |
| PREMIER WORKSITE SOLUTIONS INC3 Filed as: PREMIER WORKSITE SOLUTIONS INC. | 806 NW 79TH ST. VANCOUVER, WA 98665 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $14 | $26 | 0.09% |
| BENEFITS BY DESIGN INC3 Filed as: BENEFITS BY DESIGN INC. | 2101 NE 279TH ST. RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $6 | $18 | 0.06% |
| JOSEPH GROW III3 | 110 DICKINSON DR. BUENA VISTA, VA 24416 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.03% |
| ISAACSON INSURANCE AGENCY LLC3 | 345 CONSTITUTION WAY NORTH SALT LAKE, UT 84054 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.02% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 9.22% |
| JOHNSON RESOURCES3 | 7373 E. DOUBLETREE RANCH, STE. 200 SCOTTSDALE, AZ 85258 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $474 | — | $474 | 1.84% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP, INC. | 80 SO. 8TH ST., STE. 700 MINNEAPOLIS, MN 55402 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 9.24% |
| JOHNSON RESOURCES3 | 7373 E. DOUBLETREE RANCH, STE. 200 SCOTTSDALE, AZ 85258 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $244 | — | $244 | 1.85% |
No Schedule C service providers reported on this filing.
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 | 1,127 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | SELECTHEALTH | 858 | $3.1M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 1,003 | $240K |
| Vision(2 contracts) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 291 | $39K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,127 | $144K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,127 | $111K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,127 | $111K |
| Prescription drug(2 contracts, 2 carriers) | SELECTHEALTH | 858 | $3.1M |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,127 | $173K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,127 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.