| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHRISTY WESTERMAN | 300 CHERAPA PL - STE 601 PO BOX 5113 SIOUX FALLS, SD 57117 | DELTA DENTAL OF SOUTH DAKOTA | $3K | $0 | $3K | 1.40% |
| MARSH & MCLENNAN AGENCY LLC Filed as: MARSH & MCLENNAN AGENCY LLC C/O H+M | 300 CHERAPA PL - STE 601 PO BOX 5113 SIOUX FALLS, SD 57117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $4K | $11K | 18.88% |
| MACARIO CORPORATION | 15400 28TH AVE N STE 200 PLYMOUTH, MN 55447 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $4K | $4K | 7.00% |
| MARSH & MCLENNAN AGENCY LLC Filed as: MARSH & MCLENNAN AGENCY LLC C/O H+M | 300 CHERAPA PL - STE 601 PO BOX 5113 SIOUX FALLS, SD 57117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $148 | $3K | 7.06% |
| MARC A GROVE | 25900 AUTUMN WAY ROGERS, MN 55374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $611 | $462 | $1K | 2.90% |
| NANCY CLAUSSEN | 2309 S MACEY AVE SIOUX FALLS, SD 57106 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 2.71% |
| ELIZABETH MARIE LANGEVIN | 698 W LARPENTEUR AVE ST. PAUL, MN 55113 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $619 | $134 | $753 | 2.04% |
| ROBERT SCOTT BRUNER | 24620 E CEDAR LAKE DR NEW PRAGUE, MN 56071 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $298 | $116 | $414 | 1.12% |
| MEGHAN MOFFATT LUCAS | 2650 ACORN RUN VICTORIA, MN 55386 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $167 | $38 | $205 | 0.55% |
| JILL R LAMBERT | 12741 JEFFERSON ST NE BLAINE, MN 55434 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $143 | $33 | $176 | 0.48% |
| PAUL MARTIN WALKINGTON | 10100 SW 99 AVENUE MIAMI, FL 33176 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $92 | — | $92 | 0.25% |
| CARLOS PAEZ | 2905 NW 130TH AVE APT 102 SUNRISE, FL 33323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $77 | $0 | $77 | 0.21% |
| MARSH & MCLENNAN AGENCY LLC Filed as: MARSH & MCLENNAN AGENCY LLC C/O H+M | 33213 COLLECTION CENTER DR CHICAGO, IL 60693 | VISION SERVICE PLAN | $439 | — | $439 | 1.52% |
| MARSH & MCLENNAN AGENCY LLC Filed as: MARSH & MCLENNAN AGENCY LLC C/O H+M | 300 CHERAPA PL - STE 601 PO BOX 5113 SIOUX FALLS, SD 57117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 21.21% |
| MARSH & MCLENNAN AGENCY LLC Filed as: MARSH & MCLENNAN AGENCY LLC C/O H+M | 300 CHERAPA PL - STE 601 PO BOX 5113 SIOUX FALLS, SD 57117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $808 | $0 | $808 | 10.01% |
| MARSH & MCLENNAN AGENCY LLC Filed as: MARSH & MCLENNAN AGENCY LLC C/O H+M | 300 CHERAPA PL - STE 601 PO BOX 5113 SIOUX FALLS, SD 57117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $491 | $491 | 6.08% |
| MACARIO CORPORATION | 1540028TH AVE N STE 200 PLYMOUTH, MN 55447 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $404 | $404 | 5.00% |
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 | 326 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 326 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AVERA HEALTH PLANS, INC | 516 | $2.2M |
| Dental | DELTA DENTAL OF SOUTH DAKOTA | 245 | $199K |
| Vision | VISION SERVICE PLAN | 216 | $29K |
| Life insurance(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 335 | $105K |
| Short-term disability(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 335 | $105K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 147 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 516 | — |
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.