| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | QBE INSURANCE | $34K | $86K | $120K | 7.00% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $56K | — | $56K | 4.99% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $13K | — | $13K | 11.31% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $9K | — | $9K | 11.35% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 MEDICAL ADMINISTRATION | Claims processing; Float revenue; Other services; Participant communication; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Named fiduciary Service code 12 | — | $2.1M |
| LOCKTON COMPANIES, LLC EIN 20-3354970 BROKER | Other commissions Service code 55 | — | $235K |
| THE PRUDENTIAL INSURANCE CO. OF AM. EIN 22-1211670 STD / FMLA / EAP ADMIN. | Contract Administrator Service code 13 | — | $138K |
| DELTA DENTAL OF ILLINOIS EIN 36-2612058 DENTAL ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $64K |
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 | 2,662 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,669 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 19 | $176K |
| Vision | EYEMED VISION CARE | 2,847 | $267K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,075 | $1.1M |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,075 | $1.1M |
| Stop-loss / reinsurancereinsurance | QBE INSURANCE | 1,832 | $1.7M |
| Other(4 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,075 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,075 | — |
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.