| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVENUE CROOKSTON, MN 56716 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $3K | — | $3K | 6.70% |
| BRENDA LEE CANNING3 | 4227 THRU STREET ST CLOUD, MN 56303 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $360 | — | $360 | 0.71% |
| BLUE SKY BENEFIT SOLUTIONS INC3 | 4010 CLEARWATER RD APT 202 ST CLOUD, MN 56301 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $276 | — | $276 | 0.54% |
| MARC A GROVE3 | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $106 | $148 | $254 | 0.50% |
| DEACON CHARLES KAVANAUGH3 | 6336 HILL CREEK DR THE COLONY, TX 75056 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $203 | $48 | $251 | 0.49% |
| CBIZ BENEFITS & INSURANCE SERVICES5 | PO BOX 632886 CINCINNATI, OH 45263 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $188 | — | $188 | 0.37% |
| ROBERT SCOTT BRUNER3 | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $64 | $68 | $132 | 0.26% |
| MICHELLE J HALLER3 | 913 HUNTINGTON WAY JORDAN, MN 55352 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $73 | $13 | $86 | 0.17% |
| NATIONAL ENROLLMENT PARTNERS LLC3 | C/O NATL ENROLLMENT PARTNERS CRANSTON, RI 02920 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $36 | $25 | $61 | 0.12% |
| CARRIE S FLATEN3 | 2702 86TH CT W NORTHFIELD, MN 55057 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $59 | — | $59 | 0.12% |
| MPART BENEFITS INC3 | 100 ALBRIGHT LN PROSPER, TX 75078 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $25 | $33 | $58 | 0.11% |
| NATALIE SUZANNE FONVILLE3 | 2415 ZENITH AVE N GOLDEN VALLEY, MN 55422 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $14 | — | $14 | 0.03% |
| ELIZABETH MARIE LANGEVIN3 | 51685 BELLE ISLE DR RUSH CITY, MN 55069 | COLONIAL LIFE & ACCIDENT INSURANCE CO | $11 | — | $11 | 0.02% |
| 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 | $4K | — | $4K | 17.00% |
| HAJOSTEK, PATRICIA A3 | 1508 ALEXANDER AVENUE CROOKSTON, MN 56716 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 14.00% |
| GREG LITZ3 | 3722 SIMONVIEW CT GRAND FORKS, ND 58201 | AFLAC | $386 | — | $386 | 4.08% |
| SHAWN D BENSER3 Filed as: SHAWN BENSER | 422 SEQUOIA DR MAPLETON, ND 58059 | AFLAC | $127 | — | $127 | 1.34% |
| KIRK MOTL3 | 3101 LONGBOW CT GRAND FORKS, ND 58203 | AFLAC | $111 | — | $111 | 1.17% |
| LAWRENCE R ZAHRADKA3 Filed as: LAWRENCE ZAHRADKA | 2750 GATEWAY DR STE D GRAND FORKS, ND 58203 | AFLAC | $42 | — | $42 | 0.44% |
| JASON EARL BLAKE3 Filed as: JASON BLAKE | 1226 CULVER AVE NW BUFFALO, MN 55313 | AFLAC | $39 | — | $39 | 0.41% |
| JEREMY L TOMLINSON3 Filed as: JEREMY TOMLINSON | 6305 W RUSSETT ST BOISE, ID 83704 | AFLAC | $21 | — | $21 | 0.22% |
| CATHY J OLIVER3 Filed as: CATHY OLIVER | 14795 BOISE CIR ROSEMOUNT, MN 55068 | AFLAC | $15 | — | $15 | 0.16% |
| SASHA CAMPBELL3 | 2731 12TH AVE S STE B FARGO, ND 58103 | AFLAC | $12 | — | $12 | 0.13% |
| ERIC KENDALL3 | 1409 COTTONWOOD ST GRAND FORKS, ND 58201 | AFLAC | $9 | — | $9 | 0.10% |
| JAMES D NICHOL3 Filed as: JAMES NICHOL | 520 WELLINGTON CT WEST FARGO, ND 58078 | AFLAC | $8 | — | $8 | 0.08% |
| 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 | $4 | — | $4 | 0.04% |
| BRADY WEISENBERGER3 | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $4 | — | $4 | 0.04% |
| CYNTHIA D WELKEN-PLACE3 Filed as: CYNTHIA WELKEN-PLACE | 5335 S RANGER TRL GILBERT, AZ 85298 | AFLAC | $2 | — | $2 | 0.02% |
| PATRICIA HAJOSTEK3 | 1508 ALEXANDER AVENUE CROOKSTON, MN 56716 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 17.91% |
| VALERIE HANSON4 | 1732 WHITESTONE CIR S FARGO, ND 58103 | PREPAID LEGAL SERVICES DBA LEGALSHIELD | $394 | — | $394 | 7.55% |
| PATRICIA HAJOSTEK4 | 1508 ALEXANDER AVENUE CROOKSTON, MN 56716 | PREPAID LEGAL SERVICES DBA LEGALSHIELD | $254 | — | $254 | 4.87% |
| IDENTITY THEFT CONSULTANTS LLC4 | 20480 166TH ST NW BIG LAKE, MN 55309 | PREPAID LEGAL SERVICES DBA LEGALSHIELD | $23 | — | $23 | 0.44% |
| AZURANCE GROUP4 Filed as: AZURANCE GROUP INC | 4510 13TH AVE SW FARGO, ND 58121 | USABLE LIFE | $52 | — | $52 | 4.57% |
| MARGARET BRYANT3 Filed as: MARGARET PEDERSON-HENDERSON | 3108 26TH AVE S FARGO, ND 58103 | USABLE LIFE | $2 | — | $2 | 0.18% |
| AZURANCE GROUP5 Filed as: AZURANCE GROUP INC | 4510 13TH AVE SW FARGO, ND 58121 | USABLE LIFE | $70 | — | $70 | 20.11% |
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 | 182 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 183 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 182 | $601K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 167 | $27K |
| Life insurance(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE CO | 147 | $90K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE CO | 61 | $60K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 11 | $7K |
| Other(7 contracts, 5 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE CO | 147 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 182 | — |
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.