| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | SUN LIFE ASSURANCE COMPANY OF CANADA | $48K | $7K | $55K | 6.90% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 1.38% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 1.68% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 18.74% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $411 | $411 | 1.47% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 18.31% |
| THOMAS OWENS4 | P.O. BOX 781431 WICHITA, KS 67278 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $3K | — | $3K | 23.85% |
| MARCIA J. LEVOIR4 | 8655 BLACK MAPLE DRIVE EDEN PRARIE, MN 55344 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $17 | — | $17 | 0.14% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | PAN-AMERICAN LIFE INSURANCE COMPANY | $937 | — | $937 | 20.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 ADMINISTRATOR | Non-monetary compensation; Claims processing; Participant communication; Contract Administrator; Named fiduciary; Direct payment from the plan; Other services; Float revenue Service code 12 | — | $374K |
| LIFE INSURANCE COMPANY OF NA EIN 23-1503749 FML, STD ADMINISTRATOR | Contract Administrator Service code 13 | — | $28K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 ADMINISTRATOR | Contract Administrator Service code 13 | — | $24K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 ADMINISTRATOR | Contract Administrator; Direct payment from the plan; Claims processing; Participant communication Service code 12 | — | $10K |
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 | 534 | 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) | 534 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 388 | $66K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 972 | $156K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 557 | $152K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 442 | $790K |
| Other(5 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 847 | $98K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 972 | — |
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.