| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $10K | $10K | 1.98% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 2.65% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $3K | $9K | 9.12% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $578 | $2K | 9.55% |
| THOMAS OWENS4 Filed as: THOMAS W. OWENS | P.O. BOX 781431 WICHITA, KS 67278 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $3K | — | $3K | 23.90% |
| FREDRICK J. LEVOIR4 | 8655 BLACK MAPLE DRIVE EDEN PRAIRIE, MN 55344 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $202 | — | $202 | 1.77% |
| PARRISH & ASSOCIATES4 | 4959 MEADOW BROOK ROAD BIRMINGHAM, AL 35242 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $136 | — | $136 | 1.19% |
| GARY L. HARDEL4 | 1045 YELLOW BRICK ROAD, APT. 208 CHASKA, MN 55318 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $25 | — | $25 | 0.22% |
| MARCIA J. LEVOIR4 | 8655 BLACK MAPLE DRIVE EDEN PRARIE, MN 55344 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $16 | — | $16 | 0.14% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 ADMINISTRATOR | Non-monetary compensation; Direct payment from the plan; Contract Administrator; Other services; Participant communication; Named fiduciary; Claims processing; Float revenue Service code 12 | — | $260K |
| LIFE INSURANCE COMPANY OF NA EIN 23-1503749 STD ADMINISTRATOR | Contract Administrator Service code 13 | — | $20K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 ADMINISTRATOR | Contract Administrator Service code 13 | — | $20K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 ADMINISTRATOR | Claims processing; Contract Administrator; Direct payment from the plan; Participant communication Service code 12 | — | $9K |
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 | 444 | 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) | 444 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 349 | $63K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 817 | $102K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 471 | $109K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 936 | $523K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 705 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 936 | — |
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."
No prospect flags tripped on this filing.