| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH USA INC NY | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 100362708 | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | $30K | — | $30K | 3.65% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN DAWSON INSURANCE | 505 BROADWAY STE 100 FARGO, ND 58102 | STANDARD INSURANCE COMPANY | $17K | — | $17K | 4.98% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN DAWSON INSURANCE | 505 BROADWAY STE 100 FARGO, ND 58102 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 0.55% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN MCGRAW WENTWORTH | 250 PEHLE AVE STE 400 SADDLE BROOK, NJ 07663 | STANDARD INSURANCE COMPANY | $1K | — | $1K | 0.33% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: DAWSON INSURANCE, A MARSH & MCLENNA | P.O. BOX 1958 FARGO, ND 58107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $1K | $7K | 13.16% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN DAWSON INSURANCE | 505 BROADWAY STE 100 FARGO, ND 58102 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 5.50% |
| MARSH & MCLENNAN AGENCY LLC3 | 250 PEHLE AVE STE 400 SADDLE BROOK, NJ 07663 | STANDARD INSURANCE COMPANY | $271 | — | $271 | 0.56% |
| 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 | 0 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 991 | $813K |
| Dental | STANDARD INSURANCE COMPANY | 441 | $334K |
| Vision | STANDARD INSURANCE COMPANY | 309 | $48K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 99 | $56K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 99 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 991 | — |
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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.