| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA5 Filed as: BLUE CROSS BLUE SHIELD OF ND | 4510 13TH AVE S FARGO, ND 58121 | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | — | $526K | $526K | 19.13% |
| BLUE CROSS BLUE SHIELD OF FLORIDA5 Filed as: BLUE CROSS BLUE SHIELD OF ND | 4510 13TH AVE S FARGO, ND 58121 | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | — | $1.0M | $1.0M | 54.74% |
| BLUE CROSS BLUE SHIELD OF FLORIDA5 Filed as: BLUE CROSS BLUE SHIELD OF ND | 4510 13TH AVE S FARGO, ND 58121 | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | — | $61K | $61K | 74.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BANK OF THE WEST EIN 95-6036451 TRUSTEE | Securities brokerage commissions and fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Trustee (bank, trust company, or similar financial institution); Investment management; Investment management fees paid indirectly by plan Service code 15 | — | $31K |
| BELL STATE BANK EIN 45-6076392 TRUSTEE | Investment management; Securities brokerage commissions and fees; Trustee (bank, trust company, or similar financial institution); Recordkeeping and information management (computing, tabulating, data processing, etc.); Investment management fees paid indirectly by plan; Direct payment from the plan Service code 15 | — | $13K |
| PRIME THERAPEUTICS EIN 26-0076803 NONE | Other fees Service code 99 | — | $0 |
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 | 837 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 15 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 13 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 865 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance(3 contracts) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 4,365 | $4.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,365 | — |
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.