| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $16K | — | $16K | 1.88% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $261 | $261 | 0.03% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE, SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $43 | $43 | 0.01% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | HCC LIFE INSURANCE COMPANY | $18K | — | $18K | 5.00% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | HCC LIFE INSURANCE COMPANY | — | $18K | $18K | 4.75% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $641K |
| DISCOVERY BENEFITS FSA/HSA ADMINISTRATOR | Contract Administrator Service code 13 | — | $51K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 STD ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $41K |
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 | 1,483 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 193 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,676 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | COMBINED INSURANCE COMPANY OF AMERICA | 3,098 | $78K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,281 | $843K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,281 | $843K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 1,386 | $370K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,281 | $843K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,281 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.