| 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 | 3.54% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 100 BLOOMINGTON, MN 55437 | DELTA DENTAL OF SOUTH DAKOTA | $3K | $0 | $3K | 5.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | $3K | $11K | 20.97% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $2K | $0 | $2K | 15.01% |
| USI INSURANCE SERVICES LLC3 | 6000 CLEARWATER DRIVE MINNETONKA, MN 55343 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $557 | $0 | $557 | 6.54% |
| MARGARET MILLER AND OTHER AGENTS3 | UNKNOWN VERMILLION, SD 57401 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $88 | $0 | $88 | 1.03% |
| NATALIE SUZANNE FONVILLE3 | 2415 ZENITH AVENUE NORTH GOLDEN VALLEY, MN 55422 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $69 | $0 | $69 | 0.81% |
| TR INSURANCE ADVISORS INC3 Filed as: TR INSURANCE ADVISORS, INC. | 1009 EIGHTH AVENUE NE WASECA, MN 56093 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $57 | $0 | $57 | 0.67% |
| JOSEPH VAN DE ROSTYNE3 | UNKNOWN ABERDEEN, SD 57401 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $56 | $0 | $56 | 0.66% |
| GAIL PLUMMER3 | 4372 43RD AVENUE SOUTH FARGO, ND 58104 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $34 | $0 | $34 | 0.40% |
| MARC A GROVE3 Filed as: MARC A. GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $29 | $0 | $29 | 0.34% |
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 | 124 | 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) | 124 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AVERA HEALTH PLANS, INC. | 128 | $821K |
| Dental | DELTA DENTAL OF SOUTH DAKOTA | 146 | $63K |
| Vision | VISION SERVICE PLAN | 77 | $11K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 133 | $50K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 133 | $50K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 133 | $50K |
| Prescription drug | AVERA HEALTH PLANS, INC. | 128 | $813K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 133 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 146 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.