| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 2100 ROSS AVENUE, STE 1200 DALLAS, TX 75201 | SUN LIFE ASSURANCE COMPANY OF CANADA | $30K | $20K | $50K | 7.71% |
| THE BOON INSURANCE AGENCY3 Filed as: THE BOON INSURANCE AGENCY, INC | 6300 BRIDGEPOINT PKWY BLDG 3, STE 500 AUSTIN, TX 78730 | ACE COMPANIES | $31K | $0 | $31K | 13.64% |
| LOCKTON COMPANIES, LLC3 Filed as: MT. WEST SERIES OF LOCKTON CO. | P.O. BOX 741738 ATLANTA, GA 30374 | ACE COMPANIES | $8K | $0 | $8K | 3.36% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | P.O. BOX 123103 DALLAS, TX 75312 | BLUE CROSS BLUE SHIELD OF GEORGIA, INC. | $9K | $0 | $9K | 4.32% |
| LOCKTON COMPANIES, LLC3 | 3280 PEACHTREE ROAD NE, STE 250 ATLANTA, GA 30305 | GUARDIAN | $9K | $0 | $9K | 4.82% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | P.O. BOX 123103 DALLAS, TX 75312 | GREATER GEORGIA LIFE INSURANCE COMPANY | $5K | $0 | $5K | 6.05% |
| THE BOON INSURANCE AGENCY3 Filed as: THE BOON INSURANCE AGENCY, INC. | 6300 BRIDGEPOINT PARKWAY BUILDING 3, STE 500 AUSTIN, TX 78730 | AETNA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 14.44% |
| LOCKTON COMPANIES, LLC3 Filed as: MT. WEST SERIES OF LOCKTON CO. | P.O. BOX 741738 ATLANTA, GA 30374 | AETNA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 2.56% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | P.O. BOX 741738 ATLANTA, GA 30374 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $645 | $2K | 6.27% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | P.O. BOX 741738 ATLANTA, GA 30374 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $297 | $107 | $404 | 6.27% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 NONE | Contract Administrator; Non-monetary compensation; Direct payment from the plan; Other services; Participant communication; Named fiduciary; Claims processing; Float revenue Service code 12 | — | $649K |
| BOON ADMINISTRATIVE SERVICES, INC. EIN 33-0449333 NONE | Float revenue; Insurance services; Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | 6300 BRIDGEPOINT PARKWAY BUILDING 3, STE 500 AUSTIN, TX 78730 | $317K |
| WITHUMSMITH&BROWN, PC EIN 22-2027092 NONE | Accounting (including auditing) Service code 10 | 465 SOUTH STREET MORRISTOWN, NJ 07960 | $18K |
| CIGNA | Contract Administrator; Non-monetary compensation; Claims processing; Named fiduciary; Participant communication; Other services; Direct payment from the plan; Float revenue Service code 12 | — | $0 |
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 | 1,162 | 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) | 1,162 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,134 | $921K |
| Dental(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF GEORGIA, INC. | 1,555 | $398K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF GEORGIA, INC. | 1,555 | $398K |
| Life insurance(3 contracts, 3 carriers) | GUARDIAN | 1,220 | $319K |
| Short-term disability(2 contracts, 2 carriers) | GUARDIAN | 1,220 | $280K |
| Long-term disability(2 contracts, 2 carriers) | GUARDIAN | 1,220 | $280K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,134 | $649K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,110 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,555 | — |
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.