| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ADP INC3 Filed as: AUTOMATIC DATA PROCESSING INS AGCY | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $21K | $0 | $21K | 4.77% |
| ROGERS BENEFIT GROUP INC3 | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $19K | $19K | 4.26% |
| CLARKADAMSON, LLC3 | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $15K | $3 | $15K | 3.27% |
| ADP INC3 Filed as: AUTOMATIC DATA PROCESSING INS AGCY | 71 HANOVER RD FLORHAM PARK, NJ 07932 | SUN LIFE ASSURANCE COMPANY OF CANADA | $12K | $0 | $12K | 6.52% |
| CLARKADAMSON, LLC3 | 3603 FM 51 GAINESVILLE, TX 76240 | SUN LIFE ASSURANCE COMPANY OF CANADA | $9K | $0 | $9K | 4.65% |
| BRADLEY JOHN BOS3 | 1809 W EVERGREEN ST DURANT, OK 74701 | AFLAC | $7K | $153 | $8K | 11.79% |
| CHASTIN LYDAY-SMITH3 | 320 WESTERN HILLS DR DURANT, OK 74701 | AFLAC | $6K | $132 | $6K | 8.72% |
| ALEX DEWALD3 | 1646 N 9TH AVE DURANT, OK 74701 | AFLAC | $4K | $240 | $4K | 5.81% |
| KEVIN S. RIBERA3 Filed as: KEVIN S RIBERA | PO BOX 502 BORCHITO, OK 74726 | AFLAC | $2K | $0 | $2K | 3.07% |
| KIMBERLLY BOS3 | 1809 W EVERGREEN ST DURANT, OK 74701 | AFLAC | $1K | $0 | $1K | 1.71% |
| TIMOTHY W WORTHY JR3 Filed as: TIMOTHY B ALBRIGHT | 3525 ROCK BLUFF DR DURANT, OK 74701 | AFLAC | $967 | $0 | $967 | 1.50% |
| JOSHUA WORTHY3 Filed as: JOSHUA T WORTHY | 3700 N CLASSEN BLVD STE 220 OKLAHOMA CITY, OK 73118 | AFLAC | $473 | $30 | $503 | 0.78% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 ADMINISTRATOR | Named fiduciary; Participant communication; Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $3K |
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 | 98 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 101 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 131 | $447K |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 110 | $184K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 110 | $184K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 110 | $184K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 110 | $184K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 110 | $184K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 110 | $249K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 131 | — |
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.