| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 400 BLOOMINGTON, MN 55437 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $2K | $11K | 7.70% |
| VAALER INSURANCE INC3 Filed as: VAALER INSURANCE, INC. | 2701 SOUTH COLUMBIA ROAD GRAND FORKS, ND 58201 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $143 | $0 | $143 | 0.10% |
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DRIVE, SUITE 400 VALHALLA, NY 10595 | DELTA DENTAL OF MINNESOTA | $9K | $0 | $9K | 8.15% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF MINNESOTA | $2K | $0 | $2K | 1.74% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 400 BLOOMINGTON, MN 55437 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
| WORKPLACE SOLUTIONS, INC.3 | 120-A GILLS CREEK PARKWAY COLUMBIA, SC 29209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $625 | $5K | 60.73% |
| USI INSURANCE SERVICES LLC3 | 4300 MARKET POINTE DRIVE, SUITE 600 BLOOMINGTON, MN 55435 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 24.71% |
| BEAU DAVID BOUDREAUX3 | 120 GILLS CREEK PARKWAY COLUMBIA, SC 29209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $595 | $0 | $595 | 6.58% |
| USI INSURANCE SERVICES LLC3 | 400 HIGHWAY 169 SOUTH SAINT LOUIS PARK, MN 55426 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $224 | $224 | 2.48% |
| RUSSELL BRYDON3 | UNKNOWN BISMARK, ND 58504 | ASSURITY LIFE INSURANCE COMPANY | $320 | $0 | $320 | 19.46% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 400 BLOOMINGTON, MN 55437 | ASSURITY LIFE INSURANCE COMPANY | $132 | $0 | $132 | 8.03% |
| MICKEY GEBO3 | UNKNOWN BISMARK, ND 58504 | ASSURITY LIFE INSURANCE COMPANY | $23 | $0 | $23 | 1.40% |
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 | 399 | 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) | 399 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF MINNESOTA | 277 | $114K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 199 | $22K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 154 | $147K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 154 | $138K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 154 | $138K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 154 | $140K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 277 | — |
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.