| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | PO BOX 843844 KANSAS CITY, MO 64184 | SUN LIFE ASSURANCE COMPANY OF CANADA | $77K | — | $77K | 4.88% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 444 W 47TH STREET STE 900 IAS KANSAS CITY, MO 64112 | SUN LIFE ASSURANCE COMPANY OF CANADA | $42K | — | $42K | 2.68% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | TOKIO MARINE HCC | $56K | — | $56K | 4.59% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | PO BOX 843844 KANSAS CITY, MO 64184 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $35 | — | $35 | 2.29% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 35371 NETWORK PLACE CHICAGO, IL 60673 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $22 | — | $22 | 1.44% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 35371 NETWORK PLACE CHICAGO, IL 60673 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7 | — | $7 | 0.46% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 35371 NETWORK PLACE CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 3.47% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 35371 NETWORK PLACE CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 1.26% |
| UNITED BEHAVIORAL HEALTH DBA OPTUM3 | 11000 OPTUM CIR EDEN PRAIRIE, MN 553442503 | UNITED BEHAVIORAL HEALTH DBA OPTUM | $23K | — | $23K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MEDICARE BLUE R/X DATA PROCESSING PROVIDER | Claims processing Service code 12 | — | $1.0M |
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $867K |
| COMPREHENSIVE CARE SERVICES EIN 41-1427596 MULTIPLE SERVICE PROVIDER | Claims processing Service code 12 | — | $630K |
| SUNLIFE INSURANCE COMPANY EIN 38-1082080 STOP LOSS | Insurance agents and brokers Service code 22 | — | $171K |
| DELTA DENTAL OF MN EIN 41-0952670 DATA PROCESSING PROVIDER | Claims processing Service code 12 | — | $86K |
| BLUE CROSS BLUE SHIELD EIN 41-0984460 MULTIPLE SERVICE PROVIDER | Insurance agents and brokers Service code 22 | — | $84K |
| LOCKTON COMPANIES LLC EIN 20-3354970 BROKER | Other commissions Service code 55 | 5500 WAYZATA BLVD SUITE 510 MINNEAPOLIS, MN 554163577 | $33K |
| REILLY, PENNER & BENTON LLP EIN 39-0747409 INDEPENDENT AUDITOR | Accounting (including auditing) Service code 10 | — | $33K |
| NORTH SHORE BANK OF COMMERCE EIN 41-0138390 TRUSTEE | Trustee (discretionary) Service code 24 | 131 WEST SUPERIOR STREET DULUTH, MN 55802 | $10K |
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 | 1,183 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,316 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,499 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 2,410 | $1.6M |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 8 | $2K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 2,410 | $1.6M |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE HCC | 1,183 | $1.2M |
| Other | UNITED BEHAVIORAL HEALTH DBA OPTUM | 1,363 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,410 | — |
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.