| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NORIDIAN INSURANCE SERVICES INC3 Filed as: NORIDIAN INSURANCE SERVICES | 4510 13TH AVE SW FARGO, ND 58121 | COMPANION LIFE INS CO GROUP DENTAL INDEMNITY PLAN | $5K | — | $5K | 10.79% |
| DIRECT BENEFITS INC3 | 325 CEDAR ST #800 ST PAUL, MN 55101 | COMPANION LIFE INS CO GROUP DENTAL INDEMNITY PLAN | $2K | — | $2K | 4.89% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 581210001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $3K | $3K | 19.00% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 581210001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $767 | $767 | 19.00% |
| JOSEPH PATOCKA3 | 1616 5TH AVE NW EAST GRAND FORKS, MN 56721 | AFLAC | $2K | $103 | $2K | — |
| KIRK MOTL3 | 3101 LONGBOW CT GRAND FORKS, ND 58203 | AFLAC | $916 | — | $916 | — |
| GWEN JOHNSON3 | 105 KENSINGTON AVE PARK RIVER, ND 58270 | AFLAC | $856 | $38 | $894 | — |
| JEREMY L TOMLINSON3 Filed as: JEREMY TOMLINSON | 2805 N 36TH ST BOISE, ID 83703 | AFLAC | $503 | $44 | $547 | — |
| GREG LITZ3 | 10 S 3RD ST GRAND FORKS, ND 58201 | AFLAC | $492 | $33 | $525 | — |
| MICHAEL D EVANS JR3 Filed as: MICHAEL EVANS JR | 113 5TH ST SE WATERTOWN, SD 57201 | AFLAC | $433 | $44 | $477 | — |
| SHARON NELSON3 | 1030 N 5TH ST WARREN, MN 56762 | AFLAC | $415 | $24 | $439 | — |
| BRADLEY PRATT3 | 1522 9TH ST S FARGO, ND 58103 | AFLAC | $369 | $55 | $424 | — |
| KEITH OLSON3 | 427 31ST AVE E WEST FARGO, ND 58078 | AFLAC | $333 | — | $333 | — |
| SHAWN D BENSER3 Filed as: SHAWN BENSER | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $305 | — | $305 | — |
| ANDREW C MJONESS3 Filed as: ANDREW MJONESS | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $166 | $11 | $177 | — |
| MICHAEL C WALKER3 Filed as: MICHAEL TOMLINSON | 40 PARADISE DR WATERTOWN, SD 57201 | AFLAC | $106 | — | $106 | — |
| JAMES D NICHOL3 Filed as: JAMES NICHOL | 520 WELLINGTON CT WEST FARGO, ND 58078 | AFLAC | $99 | — | $99 | — |
| SHARI HANSON3 | 2375 5TH AVE NE NORTHWOOD, ND 58267 | AFLAC | $35 | — | $35 | — |
| BLW INC3 | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $32 | — | $32 | — |
| BRUCE HENSCHEL3 | 14815 90TH ST NE GLASSTON, ND 58236 | AFLAC | $30 | — | $30 | — |
| JUDY INGVALSON3 | 15166 13TH ST NE MAYVILLE, ND 58257 | AFLAC | $13 | — | $13 | — |
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 | 134 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 173 | $330K |
| Dental | COMPANION LIFE INS CO GROUP DENTAL INDEMNITY PLAN | 128 | $48K |
| Vision | AFLAC | 68 | $0 |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 141 | $17K |
| Short-term disability | AFLAC | 68 | $0 |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 173 | $330K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 141 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 173 | — |
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.