| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN CARVER | 3202 W MAIN ST SUITE #B RAPID CITY, SD 57702 | DAKOTACARE | $14K | — | $14K | 0.77% |
| MAGUIRE DAKOTA LLC | 820 ST JOSEPH RAPID CITY, SD 57701 | DAKOTACARE | $14K | — | $14K | 0.77% |
| DAN MAGUIRE BLACK HILLS INS AGENCY Filed as: DAN MAGUIRE | BLACK HILLS INSURANCE AGENCY INC. PO BOX 3330 RAPID CITY, SD 57709 | DELTA DENTAL OF SOUTH DAKOTA | $1K | — | $1K | 0.68% |
| JENNIFER MENTELE | WELLMARK BCBS PO BOX 5023 SIOUX FALLS, SD 57117 | DELTA DENTAL OF SOUTH DAKOTA | $263 | — | $263 | 0.13% |
| BLACK HILLS INSURANCE AGENCY Filed as: BLACK HILLS AGENCY | 820 ST JOE RAPID CITY, SD 57701 | CIGNA GROUP INSURANCE | $12K | — | $12K | 15.00% |
| BLACK HILLS INSURANCE AGENCY Filed as: BLACK HILLS AGENCY | 820 ST JOE RAPID CITY, SD 57701 | CIGNA GROUP INSURANCE | $5K | — | $5K | 15.00% |
| MIDWEST BENEFIT CONSULTANTS INC Filed as: MIDWEST BENEFIT CONSULTANTS, INC. | PO BOX 10481 DES MOINES, IA 50306 | VISION SERVICES PLAN | $977 | — | $977 | 3.51% |
| BLACK HILLS INSURANCE AGENCY Filed as: BLACK HILLS INSURANCE AGENCY INC | PO BOX 3330 RAPID CITY, SD 57709 | VISION SERVICES PLAN | $365 | — | $365 | 1.31% |
| BLACK HILLS INSURANCE AGENCY Filed as: BLACK HILLS AGENCY | 820 ST JOE RAPID CITY, SD 57701 | CIGNA GROUP INSURANCE | $2K | — | $2K | 15.00% |
| BLACK HILLS INSURANCE AGENCY Filed as: BLACK HILLS AGENCY, INC. | 820 ST. JOE RAPID CITY, SD 57709 | CHUBB | $122 | — | $122 | 15.06% |
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 | 218 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 222 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | DAKOTACARE | 332 | $1.9M |
| Dental | DELTA DENTAL OF SOUTH DAKOTA | 436 | $209K |
| Vision | VISION SERVICES PLAN | 399 | $28K |
| Life insurance | CIGNA GROUP INSURANCE | 218 | $81K |
| Long-term disability | CIGNA GROUP INSURANCE | 218 | $35K |
| Other(2 contracts, 2 carriers) | CIGNA GROUP INSURANCE | 239 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 436 | — |
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.