| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LORI LEWISON3 | WORKPLACE MARKETING 4301 WEST 57TH ST #126 SIOUX FALLS, SD 57108 | DELTA DENTAL OF SOUTH DAKOTA | $2K | — | $2K | 1.19% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC | 80 SOUTH 8TH STREET STE. 700 MINNEAPOLIS, MN 55402 | DELTA DENTAL OF SOUTH DAKOTA | $537 | — | $537 | 0.41% |
| LORI LEWISON3 | 4301 W 57TH ST STE 126 SIOUX FALLS, SD 571082258 | VISION SERVICE PLAN | $384 | — | $384 | 0.90% |
| MUTUAL MED INSURANCE SERVICES3 | 4321 E 60TH STREET DAVENPORT, IA 52807 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 12.59% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $183 | $2K | 4.17% |
| LORI D LEWISON3 Filed as: LORI D. LEWISON | 4301 W 57TH STREET SIOUX FALLS, SD 57108 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 11.31% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $987 | $132 | $1K | 4.19% |
| LEWISON, LORI D.3 | 4301 W 57TH STREET SIOUX FALLS, SD 57108 | UNUM INSURANCE COMPANY | $4K | — | $4K | 14.96% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | UNUM INSURANCE COMPANY | $8 | $3 | $11 | 0.05% |
| MUTUAL MED INSURANCE SERVICES3 | 4321 E 60TH STREET DAVENPORT, IA 52807 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 8.24% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $309 | $62 | $371 | 3.03% |
| MUTUAL MED INSURANCE SERVICES3 | 4321 E 60TH STREET DAVENPORT, IA 52807 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $484 | — | $484 | 11.29% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC | 80 SOUTH 8TH STREET MINNEAPOLIS, MN 55402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $159 | $21 | $180 | 4.20% |
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 | 302 | 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) | 302 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | WELLMARK OF SOUTH DAKOTA INC | 207 | $1.5M |
| Dental | DELTA DENTAL OF SOUTH DAKOTA | 348 | $130K |
| Vision | VISION SERVICE PLAN | 189 | $43K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 302 | $39K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 70 | $37K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 70 | $42K |
| Prescription drug | WELLMARK OF SOUTH DAKOTA INC | 207 | $1.5M |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 302 | $63K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 348 | — |
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.