| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVE CROOKSTON, MN 56716 | DELTA DENTAL | $3K | — | $3K | 2.89% |
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVE CROOKSTON, MN 56716 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $7K | $4 | $7K | 12.04% |
| BLUE SKY BENEFIT SOLUTIONS INC3 | 1500 39TH ST SOUTH ST. CLOUD, MN 56301 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $1K | $2K | $3K | 5.82% |
| BRENDA LEE CANNING3 | 4227 THRU STREET ST. CLOUD, MN 56303 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $1K | $210 | $1K | 2.19% |
| GREG LITZ3 | 10 S 3RD ST GRAND FORKS, ND 58201 | AFLAC | $876 | — | $876 | 3.62% |
| SHAWN D BENSER3 | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $273 | — | $273 | 1.13% |
| KIRK MOTL3 Filed as: KIRK A MOTL | 3101 LONGBOW CT GRAND FORKS, ND 58203 | AFLAC | $170 | — | $170 | 0.70% |
| SUSANNA GRACE DEAN3 | 314 NORTHWESTERN DRIVE GRAND FORKS, ND 58203 | AFLAC | $162 | — | $162 | 0.67% |
| LAWRENCE R ZAHRADKA3 | 1726 CEDAR STREET EMERADO, ND 58228 | AFLAC | $150 | — | $150 | 0.62% |
| JASON E BLAKE3 | 3432 CHERRY ST APT B2 GRAND FORKS, ND 58201 | AFLAC | $64 | — | $64 | 0.26% |
| SASHA CAMPBELL3 | 5685 43RD ST S FARGO, ND 58104 | AFLAC | $32 | — | $32 | 0.13% |
| JEREMY L TOMLINSON3 | 2805 N 36TH ST BOISE, ID 83703 | AFLAC | $21 | — | $21 | 0.09% |
| CATHY J OLIVER3 Filed as: CATHY OLIVER | 14795 BOISE CIR ROSEMOUNT, MN 55068 | AFLAC | $15 | — | $15 | 0.06% |
| ERIC KENDALL3 Filed as: ERIC E KENDALL | 3720 CHERRY ST APT G27 GRAND FORKS, ND 58201 | AFLAC | $12 | — | $12 | 0.05% |
| BRADY WEISENBERGER3 | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $11 | — | $11 | 0.05% |
| JOLYNNE M MACK3 Filed as: JOLYNNE MACK | 113 5TH STREET SE WATERTOWN, SD 57201 | AFLAC | $11 | — | $11 | 0.05% |
| JAMES D NICHOL3 | 520 WELLINGTON COURT WEST FARGO, ND 58078 | AFLAC | $11 | — | $11 | 0.05% |
| ENROLLEASE3 Filed as: HANRATTY & ASSOCIATES | 9800 SHELARD PKWY, STE 340 PLYMOUTH, MN 55441 | AFLAC | $9 | — | $9 | 0.04% |
| MICHAEL D EVANS JR3 Filed as: MICHAEL J TOMLINSON | 40 PARADISE DR WATERTOWN, SD 57201 | AFLAC | $6 | — | $6 | 0.02% |
| TERRY E ANDERSON3 | 700 CEDAR ST, STE 185 ALEXANDRIA, MN 56308 | AFLAC | $6 | — | $6 | 0.02% |
| CYNTHIA D WELKEN-PLACE3 | 601 CODY DR BISMARCK, ND 58503 | AFLAC | $2 | — | $2 | 0.01% |
| DONALD LARRY REYNOLDS3 | 8945 33RD ST N #B LAKE ELMO, MN 55042 | AFLAC | $1 | — | $1 | 0.00% |
| JEFFREY M HANSEN3 | 1895 52ND ST SW PEQUOT LAKES, MN 56472 | AFLAC | $1 | — | $1 | 0.00% |
| TRACI J MOORE3 | 5712 COUNTY ROAD 141 ST CLOUD, MN 56301 | AFLAC | $1 | — | $1 | 0.00% |
| NORIDIAN INSURANCE SERVICES INC3 | 4510 13TH AVE SW FARGO, ND 58121 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| DIRECT BENEFITS INC3 Filed as: DIRECT BENEFITS | 55 EAST 5TH ST #500 ST PAUL, MN 55101 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 6.00% |
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVE CROOKSTON, MN 56716 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 11.57% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 581210001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $382 | $382 | 2.78% |
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVE CROOKSTON, MN 56716 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 14.13% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 581210001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $382 | $382 | 3.20% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 58121 | USABLE LIFE | $74 | — | $74 | 5.27% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 58121 | USABLE LIFE | $229 | — | $229 | 20.03% |
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 | 194 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 195 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 173 | $473K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL | 242 | $147K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 136 | $22K |
| Life insurance(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE CO | 161 | $85K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE CO | 74 | $84K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 173 | $473K |
| Other(6 contracts, 4 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE CO | 161 | $112K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 242 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.