| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $6K | $6K | 5.36% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $7K | $14K | 13.14% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $1K | $3K | 12.10% |
| THOMAS OWENS4 Filed as: THOMAS W. OWENS | P.O. BOX 781431 WICHITA, KS 67278 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $5K | — | $5K | 31.14% |
| ALAN ROMAN4 | 24 ARUNDEL PLACE SAINT LOUIS, MO 63105 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $28 | — | $28 | 0.17% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 ADMINISTRATOR | Contract Administrator; Direct payment from the plan; Other services; Participant communication; Claims processing; Non-monetary compensation; Named fiduciary; Float revenue Service code 12 | — | $305K |
| LIFE INSURANCE COMPANY OF NA EIN 23-1503749 STD ADMINISTRATOR | Contract Administrator Service code 13 | — | $21K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 ADMINISTRATOR | Contract Administrator Service code 13 | — | $17K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 ADMINISTRATOR | Contract Administrator; Direct payment from the plan; Claims processing; Participant communication Service code 12 | — | $8K |
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 | 396 | 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) | 396 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISON SERVICE PLAN | 331 | $65K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 760 | $106K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 417 | $117K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 985 | $439K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 625 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 985 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.