| 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. | $29K | $0 | $29K | 4.08% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 400 BLOOMINGTON, MN 55437 | DELTA DENTAL OF SOUTH DAKOTA | $3K | $0 | $3K | 5.00% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 400 BLOOMINGTON, MN 55437 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | $3K | $10K | 18.99% |
| USI INSURANCE SERVICES LLC3 | 6000 CLEARWATER DRIVE MINNETONKA, MN 55343 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 7.64% |
| NATALIE SUZANNE FONVILLE3 | 2415 ZENITH AVENUE NORTH GOLDEN VALLEY, MN 55422 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $141 | $0 | $141 | 0.94% |
| TR INSURANCE ADVISORS INC3 Filed as: TR INSURANCE ADVISORS, INC. | 1009 EIGHTH AVENUE NE WASECA, MN 56093 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $140 | $0 | $140 | 0.94% |
| ZACHARY M SWARTZENDRUBER3 Filed as: ZACHARY M. SWARTZENDRUBER & AGENTS | 14128 BARIUM STREET NW ANOKA, MN 55303 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $126 | $0 | $126 | 0.84% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $61 | $0 | $61 | 0.41% |
| JOSEPH VAN DE ROSTYNE3 | UNKNOWN ABERDEEN, SD 57401 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $60 | $0 | $60 | 0.40% |
| GAIL PLUMMER3 | 4372 43RD AVENUE SOUTH FARGO, ND 58104 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $42 | $0 | $42 | 0.28% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $2K | $0 | $2K | 15.00% |
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 | 142 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 142 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AVERA HEALTH PLANS, INC. | 140 | $714K |
| Dental | DELTA DENTAL OF SOUTH DAKOTA | 146 | $60K |
| Vision | VISION SERVICE PLAN | 84 | $12K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 174 | $55K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 174 | $55K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 174 | $55K |
| Prescription drug | AVERA HEALTH PLANS, INC. | 140 | $699K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 174 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 174 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.