| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN MINNEAPOLIS | 901 MARQUETTE AVE STE 1800 MINNEAPOLIS, MN 55402 | MEDICA INSURANCE COMPANY | $19K | $316 | $19K | 2.04% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: HAYS COMPANIES INC A BROWN & BROWN | 80 S 8TH ST STE 700 MINNEAPOLIS, MN 55402 | MEDICA INSURANCE COMPANY | $17K | $316 | $17K | 1.83% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN FL MAITLAND | 2290 LUCIEN WAY STE 400 MAITLAND, FL 32751 | MEDICA INSURANCE COMPANY | $6K | $316 | $7K | 0.71% |
| HAYS COMPANIES, INC.3 | 901 MARQUETTE AVE, SUITE 1800 MINNEAPOLIS, MN 55402 | DELTA DENTAL OF MINNESOTA | $4K | $0 | $4K | 5.81% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | DELTA DENTAL OF MINNESOTA | $4K | $0 | $4K | 5.60% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $3K | $9K | 18.29% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INS AGENCY OF VA, INC | 11220 ASSETT LOOP STE 304 MANASSAS, VA 20109 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $780 | $780 | 1.55% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $628 | $3K | 6.61% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $643 | $1K | $2K | 3.89% |
| NORTH RISK PARTNERS LLC3 Filed as: NORTH RISK PARTNERS, LLC | 622 ROOSEVELT ROAD SAINT CLOUD, MN 56301 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 3.61% |
| JACQUELINE BARTHELEMY3 | 7573 HILLTON ROAD ROYALTON, MN 56373 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $975 | $29 | $1K | 2.24% |
| ANDREW JAMIN GRIMSLEY3 | 1639 GOETTENS WAY SAINT CLOUD, MN 56301 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $891 | $0 | $891 | 1.99% |
| ASHLEY MARIA HOUTMAN3 | 5447 BREEZY ROAD MOUND, MN 55364 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $678 | $47 | $725 | 1.62% |
| MEGHAN MOFFATT LUCAS3 | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $122 | $0 | $122 | 0.27% |
| ELIZABETH MARIE LANGEVIN3 | 51685 BELLE ISLE DR RUSH CITY, MN 55069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $122 | $0 | $122 | 0.27% |
| JILL R LAMBERT3 | 12741 JEFFERSON ST NE BLAINE, MN 55131 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $106 | $0 | $106 | 0.24% |
| ROBERT SCOTT BRUNER3 | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $35 | $37 | $72 | 0.16% |
| HAYS COMPANIES, INC.3 | 80 SOUTH 8TH STREET, SUITE 700 MINNEAPOLIS, MN 55402 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $975 | $0 | $975 | 14.99% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | MEDICA INSURANCE COMPANY | 280 | $983K |
| Dental | DELTA DENTAL OF MINNESOTA | 230 | $64K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 159 | $7K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 409 | $95K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 97 | $45K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 409 | $50K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 409 | $95K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 409 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.