| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BOEN & ASSOCIATES INC3 Filed as: BOEN & ASSOCIATES | 307 WEST 41ST STREET SIOUX FALLS, SD 57105 | DAKOTACARE | $9K | — | $9K | 1.79% |
| BOEN & ASSOCIATES INC3 | 307 WEST 41ST STREET PO BOX 89010 SIOUX FALLS, SD 57105 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 5.58% |
| DORNBUSCH AGENCY INC3 | 104 SOUTH LINCOLN STREET SUITE 106 ABERDEEN, SD 57401 | METROPOLITAN LIFE INSURANCE COMPANY | $900 | — | $900 | 1.76% |
| JEANNE M HARTMAN3 | 39335 BROADLAND STREET HURON, SD 57350 | AFLAC | $781 | $39 | $820 | 4.60% |
| SUSAN M KAHN3 | 8625 CUT THROAT DRIVE BILLINGS, MT 59106 | AFLAC | $626 | — | $626 | 3.51% |
| SHON FORD LLC3 Filed as: SHON S FORD | 427 NORTH BROADWAY AVENUE MILLER, SD 57362 | AFLAC | $239 | $8 | $247 | 1.38% |
| JOAN PATRICK3 | 3025 COUNTRY ROAD 139A MANDAN, ND 58554 | AFLAC | $217 | — | $217 | 1.22% |
| TERESA ROEBUCK3 | 801 SOUTH VAN EPS AVENUE SIOUX FALLS, SD 57104 | AFLAC | $215 | — | $215 | 1.20% |
| MELODY B THOMPSON3 | 1206 MAIN AVENUE SOUTH BROOKINGS, SD 57006 | AFLAC | $199 | $13 | $212 | 1.19% |
| J KAUFMANN INSURANCE, INC3 Filed as: J KAUFMANN INSURANCE INC | 2048 OVERLAND AVENUE SUITE 202 BILLINGS, MT 59102 | AFLAC | $147 | — | $147 | 0.82% |
| J THEIS & ASSOCIATES INC3 | 2048 OVERLAND AVENUE SUITE 202 BILLINGS, MT 59102 | AFLAC | $114 | — | $114 | 0.64% |
| PEAK INC3 | 1130 SOUTH BURR SUITE 300 PO BOX 514 MITCHELL, SD 57301 | AFLAC | $91 | $6 | $97 | 0.54% |
| TRACY L HOSTLER3 | 3500 SOUTH PHILLIPS AVENUE SUITE 101 SIOUX FALLS, SD 57105 | AFLAC | $78 | $13 | $91 | 0.51% |
| MARGARET A TURNER3 | 5201 SOUTH GLEN HAVEN PLACE SIOUX FALLS, SD 57108 | AFLAC | $55 | — | $55 | 0.31% |
| AWS INC3 | 1919 WEST 57TH STREET SUITE 101 SIOUX FALLS, SD 57108 | AFLAC | $54 | — | $54 | 0.30% |
| KATE PALCZEWSKI INC3 | 3412 CHISHOLM TRAIL BISMARCK, ND 58503 | AFLAC | $49 | — | $49 | 0.27% |
| MICHAEL D EVANS JR3 | 113 5TH STREET SOUTHEAST WATERTOWN, SD 57201 | AFLAC | $45 | — | $45 | 0.25% |
| AMANDA JACKSON3 | 1465 ROUGHRIDER BOULEVARD APARTMENT D302 DICKINSON, ND 58601 | AFLAC | $29 | $8 | $37 | 0.21% |
| KATHLEEN K JOHNSON3 | 610 27TH STREET WEST DICKINSON, ND 58601 | AFLAC | $26 | $10 | $36 | 0.20% |
| HEIDI ALFSON3 | 602 IRONWOOD DRIVE HARTFORD, SD 57033 | AFLAC | $34 | — | $34 | 0.19% |
| CSP INSURANCE AGENT INC3 | 4207 BOULDER RIDGE ROAD SUITE 140 BISMARCK, ND 58503 | AFLAC | $32 | — | $32 | 0.18% |
| TED HONKE3 | 1130 SOUTH BURR SUITE 200 PO BOX 514 MITCHELL, SD 57301 | AFLAC | $32 | — | $32 | 0.18% |
| ELLIE PAPINEAU LLC3 | 739 ALDRICH STREET DISKINSON, ND 58601 | AFLAC | $24 | $5 | $29 | 0.16% |
| RUSSELL C MOLSTAD JR3 | 3409 WEST MAIN STREET RAPID CITY, SD 57703 | AFLAC | $28 | — | $28 | 0.16% |
| ADELINE PELSTER3 | 3113 EDGEWOOD POINT BISMARCK, ND 58503 | AFLAC | $26 | — | $26 | 0.15% |
| JEREMY L TOMLINSON3 | 7825 WASHINGTON AVENUE SOUTH SUITE 425 MINNEAPOLIS, MN 55439 | AFLAC | $24 | — | $24 | 0.13% |
| SCOTT L WOODSON3 | 816 SOUTH 31ST STREET BILLINGS, MT 59101 | AFLAC | $23 | — | $23 | 0.13% |
| NAOMI C MCLAUGHLIN3 Filed as: NAOMI MCLAUGHLIN | 320 DEERVIEW AVENUE TEA, SD 57064 | AFLAC | $20 | — | $20 | 0.11% |
| DEBORAH J LANGENFELD HOOPS3 | PO BOX 462 HURON, SD 57350 | AFLAC | $18 | — | $18 | 0.10% |
| NICHOLE L EGEBERG BERNSDORF3 Filed as: NICHOLE EGEBERG BERNSDORF | PO BOX 297 900 JOHNSON STREET BURLINGTON, ND 58722 | AFLAC | $13 | $5 | $18 | 0.10% |
| SHAWN D BENSER3 | 4840 AMBER VALLEY PARKWAY SUITE C FARGO, ND 58104 | AFLAC | $16 | — | $16 | 0.09% |
| KRISTIE L NOSBISH3 | 1909 31ST AVENUE SOUTHWEST APARTMENT 313 MINOT, ND 58701 | AFLAC | $15 | — | $15 | 0.08% |
| AMBER MARIE LIND3 Filed as: AMBER LIND | 3409 WEST MAIN STREET RAPID CITY, SD 57702 | AFLAC | $15 | — | $15 | 0.08% |
| EUGENE BUTCH LINSTER3 Filed as: EUGENE LINSTER | 3611 ANGEL WAY COURT RAPID CITY, SD 57703 | AFLAC | $14 | — | $14 | 0.08% |
| MICHAEL D EVANS JR3 Filed as: MICHAEL J TOMLINSON | 40 PARADISE DRIVE WATERTOWN, SD 57201 | AFLAC | $13 | — | $13 | 0.07% |
| BETTY L RUSSOW3 | PO BOX 836 HOT SPRINGS, SD 57747 | AFLAC | $12 | — | $12 | 0.07% |
| DAVID AESOPH3 | 1301 SOUTH SUMMIT AVENUE SIOUX FALLS, SD 57105 | AFLAC | $12 | — | $12 | 0.07% |
| SARA KNEIP3 | 1218 6TH STREET BROOKINGS, SC 57006 | AFLAC | $10 | — | $10 | 0.06% |
| LISA HALL3 | 2542 EAST SUNDOWN DRIVE COEUR D ALENE, ID 83815 | AFLAC | $9 | — | $9 | 0.05% |
| KEVIN B VINING3 | 24747 HIDDEN VALLEY ROAD HERMOSA, SD 57744 | AFLAC | $9 | — | $9 | 0.05% |
| LISA K UHLIR3 | 8516 EAST WILLOW RIDGE PLACE SIOUX FALLS, SD 57110 | AFLAC | $7 | — | $7 | 0.04% |
| MICHAEL BOLGER3 | 128 WOODLAND DRIVE MADISON, SD 57042 | AFLAC | $5 | — | $5 | 0.03% |
| RHONDA WENBERG3 | 5 HICKORY CREEK CV LITTLE ROCK, AR 72212 | AFLAC | $5 | — | $5 | 0.03% |
| BRADY WEISENBERGER3 | 4840 AMBER VALLEY PARKWAY SOUTH SUITE C FARGO, ND 56104 | AFLAC | $4 | — | $4 | 0.02% |
| CRAIG S STADTFELD3 | 1919 WEST 57TH STREET SUITE 101 SIOUX FALLS, SD 57108 | AFLAC | $3 | — | $3 | 0.02% |
| JOLYNNE M MACK3 Filed as: JOLYNNE MACK | 113 5TH STREET SOUTHEAST WATERTOWN, SD 57201 | AFLAC | $3 | — | $3 | 0.02% |
| GERALD R THEIS JR3 | 2048 OVERLAND AVENUE SUITE 202 BILLINGS, MT 59102 | AFLAC | $3 | — | $3 | 0.02% |
| CRAIG MICHELSEN3 | 1228 25TH AVENUE SOUTHWEST GREAT FALLS, MT 59404 | AFLAC | $1 | — | $1 | 0.01% |
| JAMES PORTER3 | 223 STILLWATER CREEK DRIVE BOZEMAN, MT 59718 | AFLAC | $1 | — | $1 | 0.01% |
| DAWN D SHEUE3 Filed as: DAWN SHEUE | PO BOX 3986 JACKSON, WY 83001 | AFLAC | $1 | — | $1 | 0.01% |
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 | 91 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 93 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | DAKOTACARE | 0 | $492K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 164 | $69K |
| Vision(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 164 | $69K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 164 | $69K |
| Short-term disability | AFLAC | 23 | $18K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 164 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 164 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.