| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIAMS INSURANCE AGENCY3 | 6300 S OLD VILLAGE PLACE, STE 200 SIOUX FALLS, SD 57108 | DAKOTACARE | $6K | — | $6K | 1.33% |
| BOEN & ASSOCIATES INC3 Filed as: BOEN AND ASSOCIATES | 307 WEST 41ST STREET SIOUX FALLS, SD 67105 | DAKOTACARE | $3K | — | $3K | 0.63% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 6300 S OLD VILLAGE PLACE, STE 200 SIOUX FALLS, SD 57101 | DELTA DENTAL OF SOUTH DAKOTA | $1K | — | $1K | 3.27% |
| JEROME OWEN KRAUS3 | 2307 W 57TH ST STE 200 SIOUX FALLS, SD 57108 | NORTHWESTERN MUTUAL | $1K | $295 | $2K | 18.00% |
| ROBERT D LOWREY3 | 2307 W 57TH ST STE 200 SIOUX FALLS, SD 57108 | NORTHWESTERN MUTUAL | $284 | $25 | $309 | 3.54% |
| WILLIAMS INSURANCE AGENCY3 | 6300 S OLD VILLAGE PLACE, STE 200 SIOUX FALLS, SD 571082103 | HUMANA INSURANCE COMPANY | $3K | — | $3K | 60.00% |
| BAFFIN BAY MARKETING GROUP, LLC3 Filed as: BAFFIN BAY MARKETING GROUP | PO BOX 161690 AUSTIN, TX 78716 | HUMANA INSURANCE COMPANY | $304 | — | $304 | 7.00% |
| WILLIAMS INSURANCE AGENCY3 | 6300 S OLD VILLAGE PLACE, STE 200 SIOUX FALLS, SD 57108 | LEADERS LIFE INSURANCE COMPANY | $1K | — | $1K | 27.34% |
| BAFFIN BAY MARKETING GROUP, LLC3 Filed as: BAFFIN BAY | PO BOX 161690 AUSTIN, TX 78716 | LEADERS LIFE INSURANCE COMPANY | $180 | — | $180 | 4.27% |
| BROKER CENTRIC ALLIANCE3 Filed as: BROKER CENTRIC ALLIANCE INC. | 1350 S. BOULDER AVE., SUITE 900 TULSA, OK 74119 | LEADERS LIFE INSURANCE COMPANY | $126 | — | $126 | 2.99% |
| WILLIAMS INSURANCE AGENCY3 | 6300 S OLD VILLAGE PLACE, STE 200 SIOUX FALLS, SD 571082103 | HUMANA INSURANCE COMPANY | $2K | — | $2K | 59.99% |
| BAFFIN BAY MARKETING GROUP, LLC3 Filed as: BAFFIN BAY MARKETING GROUP | PO BOX 161690 AUSTIN, TX 78716 | HUMANA INSURANCE COMPANY | $268 | — | $268 | 8.01% |
| WILLIAMS INSURANCE AGENCY3 Filed as: WILLIAMS INSURANCE AGENCY INC. | 6300 S OLD VILLAGE PLACE, STE 200 SIOUX FALLS, SD 57108 | COMPANION LIFE INSURANCE COMPANY | $301 | — | $301 | 12.52% |
| DAKOTACARE ADMINISTRATIVE SERVICES5 Filed as: DAKOTACARE ADMIN SERVICES INC. | P.O. BOX 7406 SIOUX FALLS, SD 57117 | COMPANION LIFE INSURANCE COMPANY | $240 | — | $240 | 9.98% |
| SUMMIT REINSURANCE SERVICES INC3 Filed as: SUMMIT REINSURANCE SERVICES INC. | 7030 POINTE INVERNESS WAY, STE 350 FORT WAYNE, IN 46804 | COMPANION LIFE INSURANCE COMPANY | $48 | — | $48 | 2.00% |
| WILLIAMS INSURANCE AGENCY3 | 6300 S OLD VILLAGE PLACE, STE 200 SIOUX FALLS, SD 571082103 | HUMANA INSURANCE COMPANY | $293 | — | $293 | 60.04% |
| BAFFIN BAY MARKETING GROUP, LLC3 Filed as: BAFFIN BAY MARKETING GROUP | PO BOX 161690 AUSTIN, TX 78716 | HUMANA INSURANCE COMPANY | $39 | — | $39 | 7.99% |
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 | 140 | 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) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | DAKOTACARE | 117 | $419K |
| Dental | DELTA DENTAL OF SOUTH DAKOTA | 96 | $32K |
| Life insurance | COMPANION LIFE INSURANCE COMPANY | 140 | $2K |
| Short-term disability | LEADERS LIFE INSURANCE COMPANY | 7 | $4K |
| Long-term disability | NORTHWESTERN MUTUAL | 62 | $9K |
| Other(4 contracts, 2 carriers) | HUMANA INSURANCE COMPANY | 140 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 140 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.