| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NORIDIAN INSURANCE SERVICES INC3 Filed as: NORIDIAN INSURANCE | 4510 13TH AVE SW FARGO, ND 52121 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $26K | $26K | 11.52% |
| NORIDIAN INSURANCE SERVICES INC3 Filed as: NORIDIAN INSURANCE | 4510 13TH AVE SW FARGO, ND 52121 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $39K | $39K | 19.00% |
| NORIDIAN INSURANCE SERVICES INC3 Filed as: NORIDIAN INSURANCE | 4510 13TH AVE SW FARGO, ND 52121 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $10K | — | $10K | 10.00% |
| DIRECT BENEFITS INC3 Filed as: DIRECT BENEFITS | 325 CEDAR STREET STE 800 SAINT PAUL, MN 55101 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $8K | — | $8K | 8.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRIME THERAPEUTICS | Other fees Service code 99 | 1305 CORPORATE CENTER DRIVE EAGAN, MN 55121 | $0 |
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 | 2,183 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 55 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 38 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,276 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 2,871 | $2.3M |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 1,590 | $104K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,985 | $429K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,985 | $222K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 2,871 | $2.3M |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,985 | $429K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,871 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.