| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AP BENEFIT ADVISORS, LLC3 | 200 INTERNATIONAL CIRCLE, STE 4500 HUNT VALLEY, MD 21030 | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | $156K | — | $156K | 2.28% |
| AZURANCE GROUP3 Filed as: AZURANCE GROUP INC | 4510 13TH AVE S FARGO, ND 58121 | DDMN ASO, LLC | $7K | — | $7K | 1.34% |
| CARUTH, JENNON, M3 Filed as: CARUTH, JENNON M | 6400 FLYING CLOUD DR STE 215 EDEN PRAIRIE, MN 55344 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $41K | $4K | $45K | 17.48% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 58121 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $37K | $2K | $39K | 15.10% |
| GUCKERT, HUGO, CHRISTOPHER3 | 4500 BLACK ROCK RD HAMPSTEAD, MD 21074 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 0.54% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 58121 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $17K | $17K | 11.15% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 58121 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $13K | $13K | 11.05% |
| CARUTH, JENNON, M3 Filed as: CARUTH, JENNON M | 6400 FLYING CLOUD DR STE 215 EDEN PRAIRIE, MN 55344 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $53K | $3K | $56K | 52.24% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 58121 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $35K | $1K | $36K | 33.95% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNUM LIFE INSURANCE CO OF AMERICA EIN 01-0278678 STD ADMIN | Claims processing; Contract Administrator Service code 12 | — | $42K |
| DISCOVERY BENEFITS EIN 90-0058554 FSA/HSA ADMIN | Claims processing Service code 12 | — | $34K |
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 | 1,765 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 19 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 46 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,830 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 1,250 | $6.8M |
| Dental | DDMN ASO, LLC | 683 | $542K |
| Vision | VISION SERVICE PLAN | 996 | $126K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,765 | $151K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,765 | $151K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 1,250 | $6.8M |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,765 | $636K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,765 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.