| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARK WILLIAM FRITZEN3 | PO BOX 70025 VANCOUVER, WA 98665 | AETNA LIFE INSURANCE COMPANY | $4K | $38K | $42K | 3.19% |
| JENNON M CARUTH3 Filed as: JENNON M. CARUTH | 7825 WASHINGTON AVENUE SOUTH SUITE 710 BLOOMINGTON, MN 55439 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $267 | $4K | 11.98% |
| MARK WILLIAM FRITZEN3 | 10705 NE 25TH PLACE VANCOUVER, WA 98686 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 6.54% |
| THOMAS W. MAYER3 | 55 EAST 5TH STREET ST. PAUL, MN 55101 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $325 | $0 | $325 | 0.93% |
| THOMAS W. MAYER3 | 55 EAST 5TH STREET ST. PAUL, MN 55101 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $0 | $6K | 50.53% |
| JENNON M CARUTH3 Filed as: JENNON M. CARUTH | 7825 WASHINGTON AVENUE SOUTH SUITE 710 BLOOMINGTON, MN 55439 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $269 | $5K | 40.90% |
| DIRECT BUSINESS | 7650 EDINBOROUGH WAY, SUITE 245 EDINA, MN 55435 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $0 | $4K | 38.56% |
| MARK WILLIAM FRITZEN3 | 10705 NE 25TH PLACE VANCOUVER, WA 98686 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $406 | $0 | $406 | 3.53% |
| MARK WILLIAM FRITZEN3 | 10705 NE 25TH PLACE VANCOUVER, WA 98686 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 15.00% |
| MARK WILLIAM FRITZEN3 | 10705 NE 25TH PLACE VANCOUVER, WA 98686 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 15.00% |
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 | 144 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 146 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 205 | $1.3M |
| Dental | AETNA LIFE INSURANCE COMPANY | 205 | $1.3M |
| Life insurance(3 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 44 | $31K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 40 | $10K |
| Prescription drug | AETNA LIFE INSURANCE COMPANY | 205 | $1.3M |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 129 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 205 | — |
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.