| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | MEDICA INSURANCE COMPANY | $55K | $9K | $65K | 5.86% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $16K | — | $16K | 2.86% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $138 | $138 | 0.03% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE, SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $23 | $23 | 0.00% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 400 BLOOMINGTON, MN 55437 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 12.79% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $2K | $4K | 12.00% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $466 | $3K | 12.08% |
| LOCKTON COMPANIES, LLC3 | P.O. BOX 123042 DALLAS, TX 75312 | METROPOLITAN LIFE INSURANCE COMPANY | $108 | — | $108 | 0.39% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $425 | $4K | 18.31% |
| LOCKTON COMPANIES, LLC3 | P.O. BOX 123042 DALLAS, TX 75312 | METROPOLITAN LIFE INSURANCE COMPANY | $224 | — | $224 | 0.99% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $321 | $3K | 17.21% |
| LOCKTON COMPANIES, LLC3 | P.O. BOX 123042 DALLAS, TX 75312 | METROPOLITAN LIFE INSURANCE COMPANY | $150 | — | $150 | 0.84% |
| STEVE BAKER4 | 153 ESTHER DRIVE COCOA BEACH, FL 32931 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $3K | — | $3K | 23.92% |
| USI INSURANCE SERVICES LLC4 | 8000 NORMAN CENTER DRIVE, SUITE 400 BLOOMINGTON, MN 55413 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $227 | — | $227 | 1.84% |
| LOCKTON COMPANIES, LLC4 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $104 | — | $104 | 0.84% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MEDICA SELF-INSURED EIN 41-1479417 MEDICAL ADMINISTRATOR | Contract Administrator Service code 13 | — | $909K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 STD/FMLA ADMINISTRATOR | Contract Administrator Service code 13 | — | $46K |
| DDMN ASO, LLC EIN 41-1905554 DENTAL ADMINISTRATOR | Contract Administrator Service code 13 | — | $39K |
| BENEFIT EXTRAS, INC. FSA/HRA ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 1815 BURNSVILLE, MN 55337 | $20K |
| OPTUMINSIGHT, INC EIN 41-1858498 ADMINISTRATOR | Contract Administrator Service code 13 | — | $9K |
| COMPSYCH EIN 35-3739783 ADMINISTRATOR | Contract Administrator Service code 13 | — | $8K |
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 | 788 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 793 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 294 | $68K |
| Vision | EYEMED VISION CARE | 917 | $52K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,018 | $543K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,018 | $543K |
| Stop-loss / reinsurancereinsurance | MEDICA INSURANCE COMPANY | 1,395 | $1.1M |
| Other(6 contracts, 5 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,018 | $650K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,395 | — |
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.