| 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 | 1.98% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 400 BLOOMINGTON, MN 55437 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $15K | $965 | $16K | 15.97% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | UNION SECURITY INSURANCE COMPANY | $9K | $876 | $10K | 10.94% |
| SARA PETERSEK3 Filed as: SARA C. PETERSEK | 28665 326TH AVENUE COLOME, SD 57528 | CONTINENTAL AMERICAN INSURANCE COMPANY | $17K | $0 | $17K | 43.46% |
| ASTON CONNELL3 | 114 NORTH MAIN STREET MITCHELL, SD 57301 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | $0 | $4K | 9.33% |
| PERFORMANCE PLUS LLC3 | 105 ANDREWS MITCHELL, SD 57301 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3K | — | $3K | 6.68% |
| ERIC PALMER3 Filed as: ERIC D. PALMER | 105 ANDREWS STREET MITCHELL, SD 57301 | CONTINENTAL AMERICAN INSURANCE COMPANY | $924 | $0 | $924 | 2.40% |
| USI INSURANCE SERVICES LLC3 | 400 HIGHWAY 169 SOUTH, 8TH FLOOR SAINT LOUIS PARK, MN 55426 | UNION SECURITY INSURANCE COMPANY | $4K | $0 | $4K | 20.00% |
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 | 186 | 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) | 186 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AVERA HEALTH PLANS, INC. | 369 | $1.4M |
| Dental | UNION SECURITY INSURANCE COMPANY | 115 | $94K |
| Vision(2 contracts, 2 carriers) | AVERA HEALTH PLANS, INC. | 369 | $1.5M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 186 | $100K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 186 | $100K |
| Prescription drug | AVERA HEALTH PLANS, INC. | 369 | $1.4M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 186 | $157K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 369 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.