| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOSEPH PATOCKA3 | 1616 5TH AVE NW EAST GRAND FORKS, MN 56721 | AFLAC | $3K | $110 | $3K | 4.16% |
| LAWRENCE R ZAHRADKA3 Filed as: LAWRENCE ZAHRADKA | 10 3RD ST GRAND FORKS, ND 58201 | AFLAC | $1K | $36 | $1K | 1.93% |
| GREG LITZ3 | 10 S 3RD ST GRAND FORKS, ND 58201 | AFLAC | $1K | $46 | $1K | 1.68% |
| JON BENEDA3 | 303 HOLTEN ST LANKIN, ND 58250 | AFLAC | $923 | $68 | $991 | 1.55% |
| KIRK MOTL3 | 3101 LONGBOW CT GRAND FORKS, ND 58203 | AFLAC | $796 | $10 | $806 | 1.26% |
| GWEN JOHNSON3 | 105 KENSINGTON AVE PARK RIVER, ND 58270 | AFLAC | $593 | $51 | $644 | 1.01% |
| ANTHONY MEYER3 | 1124 LINDSEY LN GRAND FORKS, ND 58201 | AFLAC | $462 | — | $462 | 0.72% |
| JEREMY L TOMLINSON3 Filed as: JEREMY TOMLINSON | 2805 N 36TH ST BOISE, ID 83703 | AFLAC | $343 | — | $343 | 0.54% |
| SHAWN D BENSER3 Filed as: SHAWN BENSER | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $332 | $7 | $339 | 0.53% |
| MICKIE DEPAOLIS3 | 409 OAK RD PORTLAND, ND 58274 | AFLAC | $259 | — | $259 | 0.41% |
| MICHAEL D EVANS JR3 Filed as: MICHAEL EVANS JR | 113 5TH ST SE WATERTOWN, SD 57201 | AFLAC | $147 | — | $147 | 0.23% |
| KATRINA REINKE3 | 1503 6TH AVE N WAHPETON, ND 58075 | AFLAC | $84 | $42 | $126 | 0.20% |
| BRADLEY PRATT3 | 1522 9TH ST S FARGO, ND 58103 | AFLAC | $110 | — | $110 | 0.17% |
| ANDREW C MJONESS3 Filed as: ANDREW MJONESS | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $101 | — | $101 | 0.16% |
| JAMES D NICHOL3 Filed as: JAMES NICHOL | 520 WELLINGTON CT WEST FARGO, ND 58078 | AFLAC | $100 | — | $100 | 0.16% |
| MICHAEL C WALKER3 Filed as: MICHAEL TOMLINSON | 40 PARADISE DR WATERTOWN, SD 57201 | AFLAC | $91 | — | $91 | 0.14% |
| KEITH OLSON3 | 427 31ST AVE E WEST FARGO, ND 58078 | AFLAC | $71 | — | $71 | 0.11% |
| JASON OCHSENDORF3 | 3761 16TH ST S MOORHEAD, MN 56560 | AFLAC | $68 | — | $68 | 0.11% |
| SHARON NELSON3 | 1030 N 5TH ST WARREN, MN 56762 | AFLAC | $65 | — | $65 | 0.10% |
| JOLYNNE M MACK3 Filed as: JOLYNNE MACK | 113 5TH ST SE WATERTOWN, SD 57201 | AFLAC | $27 | — | $27 | 0.04% |
| BRADY WEISENBERGER3 | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $27 | — | $27 | 0.04% |
| BLW INC3 | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $23 | — | $23 | 0.04% |
| BRUCE HENSCHEL3 | 14815 90TH ST NE GLASSTON, ND 58236 | AFLAC | $16 | — | $16 | 0.03% |
| SHARI HANSON3 | 2375 5TH AVE NE NORTHWOOD, ND 58267 | AFLAC | $9 | — | $9 | 0.01% |
| DAVID J MCCLELLAN3 Filed as: DAVID AESOPH | 2700 W NICOLE DR SIOUX FALLS, SD 57105 | AFLAC | $6 | — | $6 | 0.01% |
| JUDY INGVALSON3 | 15166 13TH ST NE MAYVILLE, ND 58257 | AFLAC | $3 | — | $3 | 0.00% |
| SARA KNEIP3 | 1218 6TH ST BROOKINGS, SD 57006 | AFLAC | $3 | — | $3 | 0.00% |
| KARA M CARMODY3 Filed as: KARA CARMODY | 718 HOYT AVE E ST PAUL, MN 55106 | AFLAC | $3 | — | $3 | 0.00% |
| WILLIAM M BARNETT3 Filed as: WILLIAM BARNETT | 703 N SAGEHORN DR HARTFORD, SD 57033 | AFLAC | $2 | — | $2 | 0.00% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 58121 | COMPANION LIFE INS CO GROUP DENTAL INDEMNITY PLAN | $6K | — | $6K | 9.43% |
| DIRECT BENEFITS INC3 | 325 CEDAR ST #800 ST PAUL, MN 55101 | COMPANION LIFE INS CO GROUP DENTAL INDEMNITY PLAN | $3K | — | $3K | 4.71% |
| DENTAL MGMT CONSULTANTS3 | PO BOX 51041 PHOENIX, AZ 85076 | COMPANION LIFE INS CO GROUP DENTAL INDEMNITY PLAN | $196 | — | $196 | 0.32% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 581210001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $3K | $3K | 20.73% |
| AZURANCE GROUP3 Filed as: AZURANCE GROUP DBA NORIDIAN INSURAN | 4510 13TH AVE S FARGO, ND 58121 | FIDELITY SECURITY LIFE INSURANCE CO | $946 | — | $946 | 10.00% |
| DIRECT BENEFITS INC3 | 55 EAST 5TH ST STE 500 ST PAUL, MN 55101 | FIDELITY SECURITY LIFE INSURANCE CO | $568 | — | $568 | 6.00% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 581210001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $798 | $798 | 20.73% |
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 | 156 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 157 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 238 | $660K |
| Dental | COMPANION LIFE INS CO GROUP DENTAL INDEMNITY PLAN | 161 | $61K |
| Vision(2 contracts, 2 carriers) | AFLAC | 88 | $73K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 144 | $18K |
| Short-term disability | AFLAC | 78 | $64K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 238 | $660K |
| Other(3 contracts, 2 carriers) | AFLAC | 144 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 238 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.