| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 2487 WEST NAVIGATOR DRIVE SUITE 120 MERIDIAN, ID 83642 | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | $27K | $0 | $27K | 1.99% |
| CHELSEY N NICHOLS3 Filed as: CHELSEY NICOLE COLLINS | PO BOX 1235 MINOT, ND 58702 | AFLAC | $14K | $758 | $15K | 5.75% |
| LOARD AGENCY INC3 Filed as: LOARD AGENCY, INC. | 1520 69TH STREET NW MINOT, ND 58703 | AFLAC | $5K | $249 | $5K | 1.86% |
| LEANNE R PETERSON3 Filed as: LEANNE R. PETERSON | 603 STEVENSON STREET NW BERTHOLD, ND 58718 | AFLAC | $4K | $245 | $5K | 1.82% |
| MELISSA J SELZLER3 Filed as: MELISSA J. SELZLER | 4320 RUMELY ROAD, LOT 19 VELVA, ND 58790 | AFLAC | $3K | $264 | $4K | 1.38% |
| MAK AGENCY INC3 Filed as: MAK AGENCY, INC. | 1821 TAMMY DRIVE MINOT, ND 58701 | AFLAC | $3K | $0 | $3K | 1.23% |
| MJ INSURANCE3 Filed as: TRACEY L. BURSAU & VARIOUS AGENTS | 3309 SEDONA COURT SE MINOT, ND 58701 | AFLAC | $2K | $20 | $2K | 0.75% |
| SHELBY J BARSTAD3 Filed as: SHELBY J. BARSTAD | PO BOX 345 VELVA, ND 58790 | AFLAC | $2K | $89 | $2K | 0.70% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 6967 SOUTH RIVER GATE DRIVE SUITE 200 SALT LAKE CITY, UT 84047 | STARMOUNT LIFE INSURANCE COMPANY | $8K | $0 | $8K | 10.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | STARMOUNT LIFE INSURANCE COMPANY | $0 | $1K | $1K | 1.75% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 6967 SOUTH RIVER GATE DRIVE SUITE 200 SALT LAKE CITY, UT 84047 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 13.32% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 2.16% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $930 | $930 | 1.75% |
| CARMEN KAY BLOMS3 | 1820 13TH STREET SE, SUITE A MINOT, ND 58701 | NORTHWESTERN MUTUAL INSURANCE | $2K | $450 | $2K | 6.26% |
| JEREMY FRYE & ASSOCIATES INC3 Filed as: JEREMY TAYLOR STOWE | 275 PROMENADE STREET, SUITE 300 PROVIDENCE, RI 02908 | NORTHWESTERN MUTUAL INSURANCE | $2K | $450 | $2K | 6.26% |
| DINGER NETWORK, LLC3 | 4445 23RD AVENUE SOUTH, SUITE A FARGO, ND 58104 | NORTHWESTERN MUTUAL INSURANCE | $361 | $87 | $448 | 1.24% |
| PETER J WARREN3 Filed as: PETER J. WARREN | 275 PROMENADE STREET, SUITE 300 PROVIDENCE, RI 02908 | NORTHWESTERN MUTUAL INSURANCE | $181 | $65 | $246 | 0.68% |
| RUSSO GROUP LLC3 Filed as: RUSSO GROUP, LLC | 875 3RD AVENUE, 23RD FLOOR NEW YORK, NY 10022 | NORTHWESTERN MUTUAL INSURANCE | $181 | $22 | $203 | 0.56% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | $0 | $1K | 11.36% |
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 | 182 | 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) | 182 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 189 | $1.4M |
| Dental(2 contracts, 2 carriers) | AFLAC | 143 | $338K |
| Vision(2 contracts, 2 carriers) | AFLAC | 176 | $271K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 182 | $311K |
| Short-term disability | AFLAC | 143 | $258K |
| Long-term disability | NORTHWESTERN MUTUAL INSURANCE | 162 | $36K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 189 | $1.4M |
| Other(2 contracts, 2 carriers) | AFLAC | 182 | $311K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 189 | — |
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.