| 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. | $36K | $0 | $36K | 1.64% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $12K | $0 | $12K | 9.89% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62817 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $19K | $0 | $19K | 16.32% |
| SARA PETERSEK3 Filed as: SARA CHRISTINE PETERSEK | 28665 326TH AVENUE COLOME, SD 57528 | CONTINENTAL AMERICAN INSURANCE COMPANY | $523 | $0 | $523 | 1.01% |
| PERFORMANCE PLUS LLC3 Filed as: PERFORMANCE PLUS, LLC | 105 ANDREWS MITCHELL, SD 57301 | CONTINENTAL AMERICAN INSURANCE COMPANY | $197 | $0 | $197 | 0.38% |
| ASHTON L CONNELL3 Filed as: ASHTON LEE CONNELL | 1204 EAST 3RD AVENUE MITCHELL, SD 57301 | CONTINENTAL AMERICAN INSURANCE COMPANY | $163 | $0 | $163 | 0.32% |
| ERIC PALMER3 Filed as: ERIC DAVID PALMER | 105 ANDREWS MITCHELL, SD 57301 | CONTINENTAL AMERICAN INSURANCE COMPANY | $10 | $0 | $10 | 0.02% |
| DARREN J FERNER3 Filed as: DARREN J. FERNER | 301 BOBWHITE CIRCLE DAKOTA DUNES, SD 57049 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2 | $0 | $2 | 0.00% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 100 BLOOMINGTON, MN 55437 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | $706 | $4K | 26.11% |
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 | 259 | 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) | 259 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AVERA HEALTH PLANS, INC. | 425 | $2.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 171 | $124K |
| Vision(2 contracts, 2 carriers) | AVERA HEALTH PLANS, INC. | 425 | $2.3M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 259 | $116K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 259 | $116K |
| Prescription drug | AVERA HEALTH PLANS, INC. | 425 | $2.2M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 259 | $184K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 425 | — |
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.