| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | HCC LIFE INSURANCE COMPANY | — | $15K | $15K | 5.00% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $989 | $3K | 1.95% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | — | $10K | 15.00% |
| PAYCOM PAYROLL LLC5 | 7501 WEST MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 3.56% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 10.00% |
| PAYCOM PAYROLL LLC3 | 7501 WEST MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 4.70% |
| PAYCOM PAYROLL LLC5 | 7501 WEST MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 8.66% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| PAYCOM PAYROLL LLC5 | 7501 WEST MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $670 | $670 | 2.82% |
| PAYCOM PAYROLL LLC5 | 7501 WEST MEMORIAL ROAD OKLAHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 13.99% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | NATIONAL UNION FIRE INSURANCE CO. | $190 | — | $190 | 20.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $147K |
| WELLWORKS FOR YOU EIN 26-3082277 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $16K |
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 | 289 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 293 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 718 | $171K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 718 | $171K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 389 | $80K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 132 | $48K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 389 | $26K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 286 | $303K |
| Other(4 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 478 | $105K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 718 | — |
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.