| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVENUE CROOKSTON, MN 56716 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| HAJOSTEK, PATRICIA A3 | 1508 ALEXANDER AVENUE CROOKSTON, MN 56716 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 14.00% |
| HAJOSTEK, PATRICIA A3 | 1508 ALEXANDER AVENUE CROOKSTON, MN 56716 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 17.00% |
| GREG LITZ3 | 3722 SIMONVIEW CT GRAND FORKS, ND 58201 | AFLAC | $413 | — | $413 | 4.07% |
| SHAWN D BENSER3 Filed as: SHAWN BENSER | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $133 | — | $133 | 1.31% |
| KIRK MOTL3 | 3101 LONGBOW CT GRAND FORKS, ND 58203 | AFLAC | $111 | — | $111 | 1.09% |
| LAWRENCE R ZAHRADKA3 Filed as: LAWRENCE ZAHRADKA | 2750 GATEWAY DR STE D GRAND FORKS, ND 58203 | AFLAC | $60 | — | $60 | 0.59% |
| JASON EARL BLAKE3 Filed as: JASON BLAKE | 1226 CULVER AVE NW BUFFALO, MN 55313 | AFLAC | $39 | — | $39 | 0.38% |
| JEREMY L TOMLINSON3 Filed as: JEREMY TOMLINSON | 6305 W RUSSETT ST BOISE, ID 83704 | AFLAC | $21 | — | $21 | 0.21% |
| CATHY J OLIVER3 Filed as: CATHY OLIVER | 14795 BOISE CIR ROSEMOUNT, MN 55068 | AFLAC | $15 | — | $15 | 0.15% |
| SASHA CAMPBELL3 | 2731 12TH AVE S STE B FARGO, ND 58103 | AFLAC | $12 | — | $12 | 0.12% |
| JAMES D NICHOL3 Filed as: JAMES NICHOL | 520 WELLINGTON CT WEST FARGO, ND 58078 | AFLAC | $11 | — | $11 | 0.11% |
| ERIC KENDALL3 | 1409 COTTONWOOD ST GRAND FORKS, ND 58201 | AFLAC | $9 | — | $9 | 0.09% |
| MICHAEL C WALKER3 Filed as: MICHAEL TOMLINSON | 40 PARADISE DR WATERTOWN, SD 57201 | AFLAC | $6 | — | $6 | 0.06% |
| JOLYNNE M MACK3 Filed as: JOLYNNE MACK | 1301 4TH ST NE WATERTOWN, SD 57201 | AFLAC | $5 | — | $5 | 0.05% |
| BRADY WEISENBERGER3 | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $5 | — | $5 | 0.05% |
| CYNTHIA D WELKEN-PLACE3 Filed as: CYNTHIA WELKEN-PLACE | 5335 S RANGER TRL GILBERT, AZ 85298 | AFLAC | $2 | — | $2 | 0.02% |
| VALERIE HANSON4 | 1732 WHITESTONE CIR S FARGO, ND 58103 | PREPAID LEGAL SERVICES DBA LEGALSHIELD | $416 | — | $416 | 8.32% |
| IDENTITY THEFT CONSULTANTS LLC4 | 20480 166TH ST NW BIG LAKE, MN 55309 | PREPAID LEGAL SERVICES DBA LEGALSHIELD | $171 | — | $171 | 3.42% |
| PATRICIA HAJOSTEK4 | 1508 ALEXANDER AVENUE CROOKSTON, MN 56716 | PREPAID LEGAL SERVICES DBA LEGALSHIELD | $87 | — | $87 | 1.74% |
| AZURANCE GROUP4 Filed as: AZURANCE GROUP INC | 4510 13TH AVE SW FARGO, ND 58121 | USABLE LIFE | $54 | — | $54 | 4.52% |
| MARGARET BRYANT3 Filed as: MARGARET PEDERSON-HENDERSON | 3108 26TH AVE S FARGO, ND 58103 | USABLE LIFE | $2 | — | $2 | 0.17% |
| AZURANCE GROUP5 Filed as: AZURANCE GROUP INC | 4510 13TH AVE SW FARGO, ND 58121 | USABLE LIFE | $70 | — | $70 | 20.11% |
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVENUE CROOKSTON, MN 56716 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $5K | — | $5K | — |
| BRENDA LEE CANNING3 | 4227 THRU STREET ST CLOUD, MN 56303 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $430 | — | $430 | — |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $217 | $164 | $381 | — |
| DEACON CHARLES KAVANAUGH3 | 6336 HILL CREEK DR THE COLONY, TX 75056 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $336 | $43 | $379 | — |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $211 | $163 | $374 | — |
| BLUE SKY BENEFIT SOLUTIONS INC3 | 4010 CLEARWATER RD APT 202 ST CLOUD, MN 56301 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $337 | — | $337 | — |
| CBIZ BENEFITS & INSURANCE SERVICES5 | PO BOX 632886 CINCINNATI, OH 45263 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $220 | — | $220 | — |
| MPART BENEFITS INC3 | 100 ALBRIGHT LN PROSPER, TX 75078 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $75 | $64 | $139 | — |
| CARRIE S FLATEN3 | 2702 86TH CT W NORTHFIELD, MN 55057 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $72 | — | $72 | — |
| NATALIE SUZANNE FONVILLE3 | 2415 ZENITH AVE N GOLDEN VALLEY, MN 55422 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $16 | $2 | $18 | — |
| ROBERT SCOTT BRUNER3 | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $6 | $7 | $13 | — |
| ELIZABETH MARIE LANGEVIN3 | 51685 BELLE ISLE DR RUSH CITY, MN 55069 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $12 | — | $12 | — |
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 | 171 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 172 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 168 | $414K |
| Dental | COLONIAL LIFE & ACCIDENT INSURANCE CO | 64 | $0 |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 166 | $26K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 175 | $38K |
| Short-term disability(2 contracts, 2 carriers) | AFLAC | 64 | $10K |
| Other(7 contracts, 5 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 175 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 175 | — |
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.