| 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. | $34K | $0 | $34K | 1.90% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $14K | $0 | $14K | 11.10% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $14K | $1K | $15K | 14.76% |
| SARA PETERSEK3 Filed as: SARA C. PERERSEK | 28665 326TH AVENUE COLOME, SD 57528 | CONTINENTAL AMERICAN INSURANCE COMPANY | $766 | $0 | $766 | 7.91% |
| ASHTON L CONNELL3 Filed as: ASHTON CONNELL | 114 NORTH MAIN STREET MITCHELL, SD 57301 | CONTINENTAL AMERICAN INSURANCE COMPANY | $208 | $0 | $208 | 2.15% |
| PERFORMANCE PLUS LLC3 Filed as: PERFORMANCE PLUS, LLC | 105 ANDREWS STREET MITCHELL, SD 57301 | CONTINENTAL AMERICAN INSURANCE COMPANY | $148 | $0 | $148 | 1.53% |
| ERIC PALMER3 Filed as: ERIC D. PALMER | 105 ANDREWS STREET MITCHELL, SD 57301 | CONTINENTAL AMERICAN INSURANCE COMPANY | $40 | $0 | $40 | 0.41% |
| DARREN J FERNER3 Filed as: DARREN J. FERNER | 301 BOBWHITE CIRCLE DAKOTA DUNES, SD 57049 | CONTINENTAL AMERICAN INSURANCE COMPANY | $22 | $0 | $22 | 0.23% |
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 | 222 | 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) | 222 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AVERA HEALTH PLANS, INC. | 446 | $1.8M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 139 | $125K |
| Vision(2 contracts, 2 carriers) | AVERA HEALTH PLANS, INC. | 446 | $1.9M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 222 | $105K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 222 | $105K |
| Prescription drug | AVERA HEALTH PLANS, INC. | 446 | $1.8M |
| Other(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 222 | $240K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 446 | — |
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.