| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOSEPH PATOCKA3 | 1616 5TH AVE NW EAST GRAND FORKS, MN 56721 | AFLAC | $3K | $62 | $3K | 7.21% |
| GWEN JOHNSON3 | 105 KENSINGTON AVE PARK RIVER, ND 58270 | AFLAC | $1K | $45 | $1K | 2.51% |
| GREG LITZ3 | 10 S 3RD ST GRAND FORKS, ND 58201 | AFLAC | $905 | $23 | $928 | 1.94% |
| MICKIE DEPAOLIS3 | 409 OAK RD PORTLAND, ND 58274 | AFLAC | $862 | — | $862 | 1.80% |
| KIRK MOTL3 | 3101 LONGBOW CT GRAND FORKS, ND 58203 | AFLAC | $800 | — | $800 | 1.68% |
| SHAWN D BENSER3 Filed as: SHAWN BENSER | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $644 | $30 | $674 | 1.41% |
| KEITH OLSON3 | 427 31ST AVE E WEST FARGO, ND 58078 | AFLAC | $389 | $34 | $423 | 0.89% |
| JEREMY L TOMLINSON3 Filed as: JEREMY TOMLINSON | 2805 N 36TH ST BOISE, ID 83703 | AFLAC | $390 | — | $390 | 0.82% |
| BRADLEY PRATT3 | 1522 9TH ST S FARGO, ND 58103 | AFLAC | $356 | — | $356 | 0.75% |
| MICHAEL D EVANS JR3 Filed as: MICHAEL EVANS JR | 113 5TH ST SE WATERTOWN, SD 57201 | AFLAC | $203 | $30 | $233 | 0.49% |
| ANDREW C MJONESS3 Filed as: ANDREW MJONESS | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $163 | $7 | $170 | 0.36% |
| JAMES D NICHOL3 Filed as: JAMES NICHOL | 520 WELLINGTON CT WEST FARGO, ND 58078 | AFLAC | $100 | — | $100 | 0.21% |
| MICHAEL C WALKER3 Filed as: MICHAEL TOMLINSON | 40 PARADISE DR WATERTOWN, SD 57201 | AFLAC | $96 | — | $96 | 0.20% |
| SHARON NELSON3 | 1030 N 5TH ST WARREN, MN 56762 | AFLAC | $72 | $11 | $83 | 0.17% |
| SHARI HANSON3 | 2375 5TH AVE NE NORTHWOOD, ND 58267 | AFLAC | $25 | — | $25 | 0.05% |
| BLW INC3 | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $23 | — | $23 | 0.05% |
| BRUCE HENSCHEL3 | 14815 90TH ST NE GLASSTON, ND 58236 | AFLAC | $17 | — | $17 | 0.04% |
| JUDY INGVALSON3 | 15166 13TH ST NE MAYVILLE, ND 58257 | AFLAC | $7 | — | $7 | 0.01% |
| NORIDIAN INSURANCE SERVICES INC3 | 510 13TH AVE SW FARGO, ND 58121 | DELTA DENTAL OF MINNESOTA | $4K | — | $4K | 10.00% |
| DIRECT BENEFITS INC3 | 325 CEDAR ST #800 ST PAUL, MN 55101 | DELTA DENTAL OF MINNESOTA | $2K | — | $2K | 5.00% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 581210001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 19.00% |
| AZURANCE GROUP3 Filed as: AZURANCE GROUP DBA NORIDIAN INSURAN | 4510 13TH AVE S FARGO, ND 58121 | FIDELITY SECURITY LIFE INSURANCE CO | $669 | — | $669 | 9.99% |
| DIRECT BENEFITS INC3 | 55 EAST 5TH ST STE 500 ST PAUL, MN 55101 | FIDELITY SECURITY LIFE INSURANCE CO | $401 | — | $401 | 5.99% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 581210001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $899 | $899 | 18.99% |
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 | 165 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 197 | $411K |
| Dental | DELTA DENTAL OF MINNESOTA | 103 | $37K |
| Vision(2 contracts, 2 carriers) | AFLAC | 74 | $54K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 175 | $17K |
| Short-term disability | AFLAC | 73 | $48K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 197 | $411K |
| Other(3 contracts, 2 carriers) | AFLAC | 175 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 197 | — |
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."
No prospect flags tripped on this filing.