| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AON CONSULTING INC3 | PO BOX 905188 CHARLOTTE, NC 28290 | STANDARD INSURANCE COMPANY | $85K | $0 | $85K | 6.30% |
| AON CONSULTING INC3 | PO BOX 905188 CHARLOTTE, NC 28290 | STANDARD INSURANCE COMPANY | $18K | $0 | $18K | 3.28% |
| AON CONSULTING INC3 Filed as: AON RISK SERVICES | BLDG C SUITE 360 13901SUTTON PARK DR SOUTH JACKSONVILLE, FL 32224 | STANDARD INSURANCE COMPANY | $31K | $0 | $31K | 9.12% |
| AON CONSULTING INC3 Filed as: AON HEWITT | PO BOX 905494 CHARLOTTE, NC 28290 | EYEMED VISION CARE | $9K | $0 | $9K | 4.61% |
| AON CONSULTING INC3 Filed as: AON HEWITT | PO BOX 905494 CHARLOTTE, NC 28290 | EYEMED VISION CARE | $9K | $0 | $9K | 4.96% |
| HELENA STORY LLC3 | 14148 MAHOGANY DR JACKSONVILLE, FL 32258 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16K | $6K | $22K | 20.62% |
| GLEN E MILLER3 | 8566 FALLBROOK CIRCLE HUNTINGTON BEACH, CA 92646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $28 | $3K | 2.73% |
| MACDOUGALL BENEFITS LLC3 | 613 S POKEBERRY PL ST JOHNS, FL 32259 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $945 | $3K | 2.61% |
| ZULMA YESENIA MAZARIEGOS3 | 302 CHESTNUT AVE SANTA ANA, CA 92701 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $4 | $3K | 2.54% |
| SAMUEL TADLOCK3 | 3713 LYNWOOD DRIVE HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $750 | $2K | $3K | 2.32% |
| GROUP SUPPLEMENTAL BENEFITS INC3 | 31805 TEMECULA PKWY TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $511 | $529 | $1K | 0.95% |
| DAVID GARCIA3 | 16888 NISQUALLI RD VICTORVILLE, CA 92395 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $298 | $546 | $844 | 0.77% |
| CARMEN LOPEZ3 | 4655 W 1ST ST LOS ANGELES, CA 90004 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $652 | $7 | $659 | 0.60% |
| JANE CONKLIN MILLER3 Filed as: JANE C MILLER | 8566 FALLBROOK CIRCLE HUNTINGTON BEACH, CA 92646 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $542 | $0 | $542 | 0.50% |
| ASSURANCE AGENCY LTD3 Filed as: INDEPENDENT ASSURANCE LLC | 613 POKEBERRY PLAC ST JOHNS, FL 32259 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $202 | $206 | $408 | 0.37% |
| MICHELLE ANN REESE3 | 9000 SPRING RD COLTON, CA 92324 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $230 | $93 | $323 | 0.30% |
| CARMEN WATSON3 | PO BOX 65663 UNIVERSITY PLACE, WA 98464 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $181 | $0 | $181 | 0.17% |
| JON C RICHERT3 Filed as: JON RICHERT | 33555 WARWICK HILLS RD YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $166 | $4 | $170 | 0.16% |
| ANTHONY SCOTT HUGHES3 | 321 STOKES CREEK DR ST AUGUSTINE, FL 32095 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $147 | $10 | $157 | 0.14% |
| YOLO ENTERPRISE INC3 Filed as: YOLO ENTERPRISES INC | 5403 HERON BAY LONG BEACH, CA 90803 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $92 | $59 | $151 | 0.14% |
| DEBORAH ANN BERRY3 | 1042 E 9TH PLACE MESA, AZ 85203 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $90 | $0 | $90 | 0.08% |
| DONNIE H VANCE3 Filed as: DONNIE VANCE | 3233 JUDGE LOTT RD LENOX, GA 31637 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $82 | $0 | $82 | 0.08% |
| VANDY LEE BLACK3 | 2808 W CHERRY LANE BOISE, ID 83705 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $63 | $0 | $63 | 0.06% |
| KENT ANTHONY SHERMAN3 | 19230 LAKE FRANCES RD SE MAPLE VALLEY, WA 98038 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | $43 | $59 | 0.05% |
| MELISSA MARCHAND3 Filed as: MELISSA DEUBERRY | 127 S 73RD ST MILWAUKEE, WI 53214 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | $0 | $31 | 0.03% |
| SANDRA L AYERS3 Filed as: SANDRA AYERS | 1036 N 31ST STREET RENTON, WA 98056 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $19 | $20 | 0.02% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WILLIAM BROWN | 32997 CASALA COURT TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $11 | $15 | 0.01% |
| JEFFREY THOMAS3 | PO BOX 11312 TEMPE, AZ 85284 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | $0 | $9 | 0.01% |
| OMAR LEON3 | 3124 N 21ST ST PHOENIX, AZ 85016 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | $0 | $9 | 0.01% |
| RENEE LOUISE ROBERTSON | 28022 231ST PLACE SE MAPLE VALLEY, WA 98038 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.00% |
| ROBERT W VESTAL3 | PO BOX 1240 DELAND, FL 32721 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.00% |
| WHITFIELD BENEFIT SOLUTIONS3 | 341 N TUDOR RD ANCHORAGE, AK 99503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.00% |
| PATRICIA FERNANDEZ3 | 1113 W MONTE CRISTO AVE PHOENIX, AZ 85023 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.00% |
| AON CONSULTING INC3 Filed as: AON HEWITT | PO BOX 905494 CHARLOTTE, NC 28290 | EYEMED VISION CARE | $4K | $0 | $4K | 5.46% |
| AON CONSULTING INC Filed as: AON HEWITT | PO BOX 905494 CHARLOTTE, NC 28290 | EYEMED VISION CARE | $4K | $0 | $4K | 5.46% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | NATIONAL UNION FIRE INS CO | $2K | $0 | $2K | 19.99% |
| AON CONSULTING INC3 Filed as: AON HEWITT | PO BOX 905494 CHARLOTTE, NC 29290 | EYEMED VISION CARE | $257 | $0 | $257 | 5.00% |
| AON CONSULTING INC3 Filed as: AON HEWITT | PO BOX 905494 CHARLOTTE, NC 29290 | EYEMED VISION CARE | $57 | $0 | $57 | 4.73% |
| AON CONSULTING INC3 Filed as: AON HEWITT | PO BOX 905494 CHARLOTTE, NC 28290 | EYEMED VISION CARE | $53 | $0 | $53 | 4.98% |
| AON CONSULTING INC3 Filed as: AON HEWITT | PO BOX 905494 CHARLOTTE, NC 28290 | EYEMED VISION CARE | $38 | $0 | $38 | 4.81% |
| AON CONSULTING INC3 Filed as: AON HEWITT | PO BOX 905494 CHARLOTTE, NC 28290 | EYEMED VISION CARE | $10 | $0 | $10 | 5.08% |
| AON CONSULTING INC3 Filed as: AON HEWITT | PO BOX 905494 CHARLOTTE, NC 28290 | EYEMED VISION CARE | $7 | $0 | $7 | 6.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMADMINISTRATION | Participant communication; Other services; Contract Administrator; Non-monetary compensation; Named fiduciary; Float revenue; Direct payment from the plan; Claims processing Service code 12 | — | $3.2M |
| BCBSM INC EIN 41-0984460 CONTRACT ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | PO BOX 64560 ST PAUL, MN 55164 | $116K |
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 | 12,866 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 74 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 12,940 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY03764A | 9 | $212K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY03764A | 9 | $212K |
| Vision(11 contracts, 2 carriers) | EYEMED VISION CARE | 3,103 | $562K |
| Life insurance(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 6,261 | $1.5M |
| Short-term disability | STANDARD INSURANCE COMPANY | 1,800 | $342K |
| Long-term disability(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 4,889 | $567K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 10,428 | $303K |
| Other(3 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY03764A | 12,866 | $330K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 12,866 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.