| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | $16K | — | $16K | 1.20% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES INC | 222 S 9TH ST STE 1000 MINNEAPOLIS, MN 55402 | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | $8K | — | $8K | 0.65% |
| ACRISURE LLC3 | BENEFIT HEALTH ADVISOR 9605 S KINGSTON CT STE 150 ENGLEWOOD, CO 80112 | STANDARD INSURANCE COMPANY | $1K | — | $1K | 4.02% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SERVICES | 222 S 9TH ST STE 1000 MINNEAPOLIS, MN 55402 | STANDARD INSURANCE COMPANY | $811 | — | $811 | 2.56% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | 9605 SOUTH KINGSTON COURT SUITE 110 ENGLEWOOD, CO 80112 | FIDELITY SECURITY LIFE | $841 | — | $841 | 7.21% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICE INC | PO BOX 632886 CINCINNATI, OH 45263 | FIDELITY SECURITY LIFE | $218 | — | $218 | 1.87% |
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 | 106 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 163 | $1.3M |
| Dental | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 163 | $1.3M |
| Vision | FIDELITY SECURITY LIFE | 145 | $12K |
| Life insurance | STANDARD INSURANCE COMPANY | 106 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 163 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.