| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MIDDAUGH BENEFITS CONSULTING INC3 Filed as: MIDDAUGH BENEFITS CONSULT | 1019 5TH AVE SOUTH FARGO, ND 58103 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 15.00% |
| MIDDAUGH BENEFITS CONSULTING INC3 Filed as: MIDDAUGH BENEFITS CONSULT | 1019 5TH AVE SOUTH FARGO, ND 58103 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 15.00% |
| AZURANCE GROUP3 Filed as: AZURANCE GROUP INC ATTN CARI HINTGE | 4510 13TH AVE SW FARGO, ND 58121 | USABLE LIFE | $120 | — | $120 | 4.53% |
| MILISSA VAN EPS3 | 1223 RHINEHART DR SE EAST GRAND FORKS, MN 56721 | USABLE LIFE | $4 | — | $4 | 0.15% |
| MIDDAUGH BENEFITS CONSULTING INC3 Filed as: MIDDAUGH BENEFITS CONSULT | 1019 5TH AVE SOUTH FARGO, ND 58103 | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | $349 | — | $349 | 14.98% |
| AZURANCE GROUP3 Filed as: AZURANCE GROUP INC ATTN CARI HINTGE | 4510 13TH AVE SW FARGO, ND 58121 | USABLE LIFE | $8 | — | $8 | 4.08% |
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 | 110 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ND | 278 | $635K |
| Life insurance | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | 147 | $16K |
| Long-term disability | CIGNA LIFE INSURANCE COMPANY OF NORTH AMERICA | 108 | $15K |
| Other(3 contracts, 2 carriers) | USABLE LIFE | 147 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 278 | — |
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.