| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 100 SUMMIT LAKE DRIVE, SUITE 400 VALHALLA, NY 10595 | AVERA HEALTH PLANS, INC. | $28K | $0 | $28K | 3.72% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE SUITE 400 BLOOMINGTON, MN 55437 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | $584 | $8K | 13.02% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE SUITE 400 BLOOMINGTON, MN 55437 | DELTA DENTAL OF SOUTH DAKOTA | $3K | $0 | $3K | 5.01% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $2K | $0 | $2K | 14.94% |
| USI INSURANCE SERVICES LLC3 | 6000 CLEARWATER DRIVE MINNETONKA, MN 55343 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $159 | $0 | $159 | 4.77% |
| NATALIE SUZANNE FONVILLE3 | 2415 ZENITH AVENUE NORTH GOLDEN VALLEY, MN 55422 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $20 | $0 | $20 | 0.60% |
| TR INSURANCE ADVISORS INC3 Filed as: TR INSURANCE ADVISORS, INC., | 1009 EIGHTH AVENUE NE WASECA, MN 56093 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $19 | $0 | $19 | 0.57% |
| JACK ALAN HENNINGSGAARD3 Filed as: JACK HENNINGSGAARD AND OTHER AGENTS | 2562 LOST LAKE ROAD MOUND, MN 55364 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $11 | $0 | $11 | 0.33% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $9 | $0 | $9 | 0.27% |
| GAIL PLUMMER3 | 4372 43RD AVENUE SOUTH FARGO, ND 58104 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $6 | $0 | $6 | 0.18% |
| ZACHARY M SWARTZENDRUBER3 Filed as: ZACHARY M. SWARTZENDRUBER | 14128 BARIUM STREET NW ANOKA, MN 55303 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.12% |
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 | 95 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 96 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AVERA HEALTH PLANS, INC. | 95 | $745K |
| Dental | DELTA DENTAL OF SOUTH DAKOTA | 155 | $60K |
| Vision | VISION SERVICE PLAN | 91 | $14K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 201 | $63K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 201 | $63K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 201 | $63K |
| Prescription drug | AVERA HEALTH PLANS, INC. | 95 | $742K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 201 | $67K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 201 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.