| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 | — | SANFORD HEALTH PLAN | $28K | $0 | $28K | 4.00% |
| MARSH & MCLENNAN AGENCY LLC3 | 2701 S COLUMBIA RD GRAND FORKS, ND 58201 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $4K | $14K | 16.54% |
| HKG INSURANCE SOLUTIONS LLC5 | 1228 N 164TH ST OMAHA, NE 68118 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 4.04% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $878 | $878 | 1.05% |
| COLE CASEY CROMPTON3 | 116 15TH ST S MOORHEAD, MN 56560 | AFLAC | $7K | $528 | $8K | 9.34% |
| ANDREW C MJONESS3 Filed as: ANDREW MJONESS | 2917 14TH AVE S MOORHEAD, MN 56560 | AFLAC | $3K | $131 | $3K | 4.08% |
| THOMAS J CASSADY3 | 1307 NP AVE N FARGO, ND 58102 | AFLAC | $1K | $105 | $1K | 1.83% |
| AMBER MUSKE3 Filed as: AMBER N MUSKE | 11769 31ST ST SE VALLEY CITY, ND 58072 | AFLAC | $804 | $85 | $889 | 1.10% |
| MICKIE DEPAOLIS3 Filed as: MICKIE C DEPAOLIS | 409 OAK RD PORTLAND, ND 58274 | AFLAC | $284 | $0 | $284 | 0.35% |
| SHARI HANSON3 Filed as: SHARI L HANSON | 2375 5TH AVE NE NORTHWOOD, ND 58267 | AFLAC | $276 | $0 | $276 | 0.34% |
| KEITH OLSON3 Filed as: KEITH A OLSON | 427 31ST AVE E WEST FARGO, ND 58078 | AFLAC | $177 | $0 | $177 | 0.22% |
| SHAWN D BENSER3 | 422 SEQUOIA DR MAPLETON, ND 58059 | AFLAC | $120 | $0 | $120 | 0.15% |
| GREG LITZ3 | 3722 SIMONVIEW CT GRAND FORKS, ND 58201 | AFLAC | $119 | $0 | $119 | 0.15% |
| JUDY INGVALSON3 Filed as: JUDY J INGVALSON | 1040 HIGHWAY 18 NE PORTLAND, ND 58257 | AFLAC | $86 | $0 | $86 | 0.11% |
| MALLORY LYNN BRITTON3 | 3011 W ELMWOOD DR GRAND FORKS, ND 58201 | AFLAC | $65 | $0 | $65 | 0.08% |
| ANDREW C MJONESS3 | 2917 14TH AVE S MOORHEAD, MN 56560 | AFLAC | $52 | $0 | $52 | 0.06% |
| JEREMY L TOMLINSON3 | 6305 W RUSSETT ST BOISE, ID 83704 | AFLAC | $29 | $0 | $29 | 0.04% |
| KIRK MOTL3 Filed as: KIRK A MOTL | 3101 LONGBOW CT GRAND FORKS, ND 58203 | AFLAC | $27 | $0 | $27 | 0.03% |
| MICHAEL D EVANS JR3 | 113 5TH ST SE WATERTOWN, SD 57201 | AFLAC | $24 | $0 | $24 | 0.03% |
| MARC A HANSON3 | 1207 PRAIRIE PARKWAY WEST FARGO, ND 58078 | AFLAC | $14 | $0 | $14 | 0.02% |
| RYAN ALLEN KOLLE3 | 3563 54TH ST S FARGO, ND 58104 | AFLAC | $13 | $0 | $13 | 0.02% |
| A P INVESTMENTS INC3 | 1128 WESTRAC DR S FARGO, ND 58103 | AFLAC | $13 | $0 | $13 | 0.02% |
| MELISSA ANN VAN EREM3 | 2301 25TH AVE S FARGO, ND 58103 | AFLAC | $10 | $0 | $10 | 0.01% |
| SANDRA F STRANDLIEN3 | 1307 NP AVE N FARGO, ND 58102 | AFLAC | $8 | $0 | $8 | 0.01% |
| MARC A HANSON3 | 5904 36TH ST S FARGO, ND 58104 | AFLAC | $4 | $0 | $4 | 0.00% |
| BRADY L WEISENBERGER3 | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $4 | $0 | $4 | 0.00% |
| CATHY J OLIVER3 | 14795 BOISE CIR ROSEMOUNT, MN 55068 | AFLAC | $4 | $0 | $4 | 0.00% |
| DAVID P AESOPH3 | 2700 W NICOLE DR SIOUX FALLS, ND 57105 | AFLAC | $3 | $0 | $3 | 0.00% |
| JOLYNNE M MACK3 | 1301 4TH ST NE WATERTOWN, SD 57201 | AFLAC | $3 | $0 | $3 | 0.00% |
| NORTH RISK PARTNERS LLC3 | 622 ROOSEVELT RD STE 240 SAINT CLOUD, MN 56301 | AFLAC | $2 | $0 | $2 | 0.00% |
| ADAM MICHEAL KOLLE3 | 3267 62ND AVE S FARGO, ND 58104 | AFLAC | $2 | $0 | $2 | 0.00% |
| SHERI R MEIS3 | 12121 165TH AVE FERGUS FALLS, MN 56537 | AFLAC | $1 | $0 | $1 | 0.00% |
| JAMES D NICHOL3 | 520 WELLINGTON CT WEST FARGO, ND 58078 | AFLAC | $1 | $0 | $1 | 0.00% |
| WILLIAM M BARNETT3 | 703 N SAGEHORN DR HARTFORD, SD 57033 | AFLAC | $1 | $0 | $1 | 0.00% |
| MICHAEL D EVANS JR3 Filed as: MICHAEL J TOMLINSON | 40 PARADISE DR WATERTOWN, SD 57201 | AFLAC | $1 | $0 | $1 | 0.00% |
| ANDREW C MJONESS3 Filed as: ANDREW MJONESS | 2917 14TH AVE S MOORHEAD, MN 56560 | AFLAC | $206 | $0 | $206 | 4.50% |
| COLE CASEY CROMPTON3 | 116 15TH ST S MOORHEAD, MN 56560 | AFLAC | $75 | $0 | $75 | 1.64% |
| AMBER MUSKE3 Filed as: AMBER N MUSKE | 11769 31ST ST SE VALLEY CITY, ND 58072 | AFLAC | $54 | $0 | $54 | 1.18% |
| THOMAS J CASSADY3 | 1307 NP AVE N FARGO, ND 58102 | AFLAC | $44 | $0 | $44 | 0.96% |
| SHAWN D BENSER3 | 422 SEQUOIA DR MAPLETON, ND 58059 | AFLAC | $21 | $0 | $21 | 0.46% |
| TODD H BURRER3 | 440 REGENCY PARKWAY DR STE 234 OMAHA, NE 68114 | AFLAC | $10 | $0 | $10 | 0.22% |
| GREG LITZ3 | 3722 SIMONVIEW CT GRAND FORKS, ND 58201 | AFLAC | $8 | $0 | $8 | 0.17% |
| MICKIE DEPAOLIS3 Filed as: MICKIE C DEPAOLIS | 409 OAK RD PORTLAND, ND 58274 | AFLAC | $8 | $0 | $8 | 0.17% |
| SHARI HANSON3 Filed as: SHARI L HANSON | 2375 5TH AVE NE NORTHWOOD, ND 58267 | AFLAC | $8 | $0 | $8 | 0.17% |
| LOARD AGENCY INC3 | 1520 69TH ST NW MINOT, ND 58703 | AFLAC | $6 | $0 | $6 | 0.13% |
| MARK ANSON3 | 18806 LAMONT ST OMAHA, NE 68130 | AFLAC | $5 | $0 | $5 | 0.11% |
| DAVID JOHN BECK3 | 19007 BOYD ST ELKHORN, NE 68022 | AFLAC | $5 | $0 | $5 | 0.11% |
| LEANNE R PETERSON3 | 603 STEVENSON ST NW BERTHOLD, ND 58718 | AFLAC | $2 | $0 | $2 | 0.04% |
| ERIN RENAE SUND3 | 2905 CRESCENT DR MINOT, ND 58703 | AFLAC | $2 | $0 | $2 | 0.04% |
| KYLE ROTH3 | 11306 SPAULDING ST OMAHA, NE 68164 | AFLAC | $2 | $0 | $2 | 0.04% |
| THOMAS EDWARD SHEFFIELD3 | PO BOX 151 MC COOL JUNCTION, NE 68401 | AFLAC | $1 | $0 | $1 | 0.02% |
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 | 120 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SANFORD HEALTH PLAN | 146 | $689K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 120 | $83K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 120 | $83K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 120 | $83K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 120 | $169K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 146 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.