| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AZURANCE GROUP3 Filed as: AZURANCE GROUP INC | 4510 13TH AVE SW FARGO, ND 58121 | COMPANION LIFE INS CO DENTAL PLAN | $6K | — | $6K | 10.18% |
| DIRECT BENEFITS INC3 | 55 EAST 5TH ST STE 500 ST PAUL, MN 55101 | COMPANION LIFE INS CO DENTAL PLAN | — | $3K | $3K | 5.09% |
| JOSEPH PATOCKA3 | 1616 5TH AVE NW EAST GRAND FORKS, MN 56721 | AFLAC | $2K | $57 | $2K | 2.64% |
| GREG LITZ3 | 10 S 3RD ST GRAND FORKS, ND 58201 | AFLAC | $759 | $57 | $816 | 1.32% |
| LAWRENCE R ZAHRADKA3 Filed as: LAWRENCE ZAHRADKA | 10 S 3RD ST GRAND FORKS, ND 58201 | AFLAC | $572 | $126 | $698 | 1.13% |
| KIRK MOTL3 | 3101 LONGBOW CT GRAND FORKS, ND 58203 | AFLAC | $688 | — | $688 | 1.11% |
| GWEN JOHNSON3 | 105 KENSINGTON AVE PARK RIVER, ND 58270 | AFLAC | $484 | — | $484 | 0.78% |
| JON BENEDA3 | 303 HOLTEN ST LANKIN, ND 58250 | AFLAC | $289 | $76 | $365 | 0.59% |
| JEREMY L TOMLINSON3 Filed as: JEREMY TOMLINSON | 6305 W RUSSETT ST BOISE, ID 83704 | AFLAC | $296 | — | $296 | 0.48% |
| SHAWN D BENSER3 Filed as: SHAWN BENSER | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $277 | — | $277 | 0.45% |
| MICKIE DEPAOLIS3 | 409 OAK RD PORTLAND, ND 58274 | AFLAC | $235 | — | $235 | 0.38% |
| DEVIN SCOTT BARTON3 | 1660 36TH AVE S APT 201 GRAND FORKS, ND 58201 | AFLAC | $127 | $48 | $175 | 0.28% |
| MICHAEL D EVANS JR3 Filed as: MICHAEL EVANS JR | 113 5TH ST SE WATERTOWN, SD 57201 | AFLAC | $126 | — | $126 | 0.20% |
| BRADLEY PRATT3 | 1522 9TH ST S FARGO, ND 58103 | AFLAC | $94 | — | $94 | 0.15% |
| JAMES D NICHOL3 Filed as: JAMES NICHOL | 520 WELLINGTON CT WEST FARGO, ND 58078 | AFLAC | $91 | — | $91 | 0.15% |
| MICHAEL C WALKER3 Filed as: MICHAEL TOMLINSON | 40 PARADISE DR WATERTOWN, SD 57201 | AFLAC | $79 | — | $79 | 0.13% |
| KEITH OLSON3 | 427 31ST AVE E WEST FARGO, ND 58078 | AFLAC | $76 | — | $76 | 0.12% |
| ANDREW C MJONESS3 Filed as: ANDREW MJONESS | 2917 14TH AVE S MOORHEAD, MN 56560 | AFLAC | $75 | — | $75 | 0.12% |
| SHARON NELSON3 | 1030 N 5TH ST WARREN, MN 56762 | AFLAC | $71 | — | $71 | 0.11% |
| KATRINA REINKE3 | 1503 6TH AVE N WAHPETON, ND 58075 | AFLAC | $58 | — | $58 | 0.09% |
| JASON OCHSENDORF3 | 3761 16TH ST S MOORHEAD, MN 56560 | AFLAC | $25 | — | $25 | 0.04% |
| BLW INC3 | 4840 AMBER VALLEY PKWY S STE C FARGO, ND 58104 | AFLAC | $25 | — | $25 | 0.04% |
| JOLYNNE M MACK3 Filed as: JOLYNNE MACK | 113 5TH ST SE WATERTOWN, SD 57201 | AFLAC | $23 | — | $23 | 0.04% |
| BRADY WEISENBERGER3 | 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 | $17 | — | $17 | 0.03% |
| SHARI HANSON3 | 2375 5TH AVE NE NORTHWOOD, ND 58267 | AFLAC | $10 | — | $10 | 0.02% |
| DAVID J MCCLELLAN3 Filed as: DAVID AESOPH | 2700 W NICOLE DR SIOUX FALLS, SD 57105 | AFLAC | $6 | — | $6 | 0.01% |
| SARA KNEIP3 | 1218 6TH ST BROOKINGS, SD 57006 | AFLAC | $4 | — | $4 | 0.01% |
| JUDY INGVALSON3 | 15166 13TH ST NE MAYVILLE, ND 58257 | AFLAC | $3 | — | $3 | 0.00% |
| KARA M CARMODY3 Filed as: KARA CARMODY | 718 HOYT AVE E ST PAUL, MN 55106 | AFLAC | $2 | — | $2 | 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 581210001 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $4K | $4K | 20.70% |
| AZURANCE GROUP3 | 4510 13TH AVE SW FARGO, ND 581210001 | FIDELITY SECURITY LIFE INSURANCE CO | $1K | — | $1K | 9.25% |
| DIRECT BENEFITS INC3 | 55 EAST 5TH ST STE 500 ST PAUL, MN 55101 | FIDELITY SECURITY LIFE INSURANCE CO | $805 | — | $805 | 5.56% |
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 | 130 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 130 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NORTH DAKOTA | 246 | $770K |
| Dental(2 contracts, 2 carriers) | COMPANION LIFE INS CO DENTAL PLAN | 166 | $125K |
| Vision(2 contracts, 2 carriers) | AFLAC | 100 | $77K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 54 | $82K |
| Short-term disability | AFLAC | 54 | $62K |
| Other(2 contracts, 2 carriers) | AFLAC | 54 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 246 | — |
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.