| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | BLUE CROSS AND BLUE SHIELD OF KANSAS CITY | $70K | $70K | $140K | 3.99% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | PRINCIPAL LIFE INSURANCE COMPANY | $30K | — | $30K | 8.83% |
| BLUE CROSS BLUE SHIELD OF FLORIDA3 Filed as: BLUE CROSS AND BLUE SHIELD OF KC | 2301 MAIN STREET KANSAS CITY, MO 64108 | PRINCIPAL LIFE INSURANCE COMPANY | — | $11K | $11K | 3.22% |
| LOCKTON COMPANIES, LLC4 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $2K | — | $2K | 17.00% |
| THOMAS OWENS4 | PO BOX 781431 WICHITA, KS 67278 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $311 | — | $311 | 2.14% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SURENCY LIFE & HEALTH INSURANCE EIN 26-1969006 ADMINISTRATOR | Contract Administrator Service code 13 | — | $25K |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF KANSAS CITY | 0 | $3.5M |
| Dental | DELTA DENTAL OF MISSOURI | 0 | $231K |
| Vision | ADVANTICA INSURANCE COMPANY | 0 | $21K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 0 | $339K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 0 | $339K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 0 | $339K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF KANSAS CITY | 0 | $3.5M |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 0 | $353K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 0 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.