| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL GREAT PLAINS LLC | UNKNOWN BISMARCK, ND 58501 | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | $33K | $0 | $33K | 1.88% |
| BRIDGET SCHAPP3 | 3131 BALTUS DR BISMARCK, ND 58501 | AFLAC | $2K | $131 | $2K | 5.12% |
| PRONORTH INSURANCE AND OTHER AGENTS3 | 204 HIGHWAY 2 WEST, SUITE B DEVILS LAKE, ND 58301 | AFLAC | $2K | $204 | $2K | 4.21% |
| NATHAN BUTLER CORBIN3 | 404 2ND AVENUE NW MANDAN, ND 58554 | AFLAC | $643 | $0 | $643 | 1.46% |
| MAK AGENCY INC3 | 1821 TAMMY DRIVE MINOT, ND 58701 | AFLAC | $341 | $46 | $387 | 0.88% |
| LYNN A BROKAW3 | 1406 SOUTH RENO DRIVE BISMARK, ND 58504 | AFLAC | $363 | $0 | $363 | 0.83% |
| CARRIE PALCZEWSKI3 Filed as: CARRIE SUE PALCZEWSKI | 1710 BURNT BOAT DRIVE, SUITE 2 BISMARCK, ND 58503 | AFLAC | $284 | $0 | $284 | 0.65% |
| MEGAN DENYAL HAAG PRAUS3 | 6715 2ND AVENUE SE HAZELTON, ND 58544 | AFLAC | $238 | $0 | $238 | 0.54% |
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 | 151 | 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) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 233 | $1.7M |
| Dental | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 233 | $1.7M |
| Vision | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 233 | $1.7M |
| Life insurance | AFLAC | 39 | $44K |
| Short-term disability | AFLAC | 39 | $44K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 233 | $1.7M |
| Other(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 233 | $1.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 233 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.