| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL GREAT PLAINS, LLC | UNKNOWN MANDAN, ND 58554 | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | $18K | $0 | $18K | 1.01% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | UNKNOWN MANDAN, ND 58554 | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | $9K | $0 | $9K | 0.51% |
| DIRECT BENEFITS INC3 Filed as: DIRECT BENEFITS | 7900 INTERNATIONAL DRIVE SUITE 1040 BLOOMINGTON, MN 55425 | AMERITAS LIFE INSURANCE CORPORATION | $7K | $0 | $7K | 9.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL GREAT PLAINS, LLC | PO BOX 542006 OMAHA, NE 68154 | AMERITAS LIFE INSURANCE CORPORATION | $4K | $0 | $4K | 4.60% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | AMERITAS LIFE INSURANCE CORPORATION | $2K | $0 | $2K | 2.40% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | ASSURITY | $9K | $0 | $9K | 18.60% |
| FARMERS UNION SVC ASSOC LTD3 Filed as: FARMERS UNION SERVICES ASSOCIATION | UNKNOWN MANDAN, ND 58554 | ASSURITY | $4K | $0 | $4K | 7.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL GREAT PLAINS, LLC | PO BOX 542006 OMAHA, NE 68154 | ASSURITY | $101 | $0 | $101 | 0.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL GREAT PLAINS, LLC | 11516 MIRACLE HILLS DRIVE SUITE 100 OMAHA, NE 68154 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $932 | $4K | 15.87% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 6.21% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | 700 WEST 47TH STREET, SUITE 1100 KANSAS CITY, MO 64112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $189 | $189 | 0.73% |
| DIRECT BENEFITS INC3 Filed as: DIRECT BENEFITS | 7900 INTERNATIONAL DRIVE SUITE 1040 BLOOMINGTON, MN 55425 | AMERITAS LIFE INSURANCE CORPORATION | $2K | $0 | $2K | 14.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL GREAT PLAINS, LLC | PO BOX 542006 OMAHA, NE 68154 | AMERITAS LIFE INSURANCE CORPORATION | $799 | $0 | $799 | 4.57% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS. | PO BOX 632886 CINCINNATI, OH 45263 | AMERITAS LIFE INSURANCE CORPORATION | $425 | $0 | $425 | 2.43% |
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 | 147 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 149 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 182 | $1.8M |
| Dental | AMERITAS LIFE INSURANCE CORPORATION | 224 | $79K |
| Vision | AMERITAS LIFE INSURANCE CORPORATION | 215 | $17K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 147 | $26K |
| Short-term disability | ASSURITY | 172 | $50K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 182 | $1.8M |
| Other(2 contracts, 2 carriers) | ASSURITY | 172 | $76K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 224 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.