| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| K&S INSURANCE AGENCY3 Filed as: K & S INSURANCE AGENCY | PO BOX 277 ROCKWALL, TX 75087 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILITATES (CIGNA) | $4K | $0 | $4K | 8.29% |
| INSGROUP INC3 Filed as: INSGROUP, LLC | 5151 SAN FELIPE 24TH FLOOR HOUSTON, TX 77056 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILITATES (CIGNA) | $799 | $0 | $799 | 1.58% |
| K&S INSURANCE AGENCY3 | PO BOX 277 ROCKWALL, TX 75087 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILITATES (CIGNA) | $2K | $0 | $2K | 15.00% |
| K&S INSURANCE AGENCY3 | PO BOX 277 ROCKWALL, TX 75087 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILITATES (CIGNA) | $2K | $0 | $2K | 15.00% |
| WHITE HILL PLAZA INC3 Filed as: WHITE HILL PLAZA INC. DBA K&S INS A | P. O. BOX 277 ROCKWALL, TX 75087 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $732 | $0 | $732 | 9.99% |
| K&S INSURANCE AGENCY3 | PO BOX 277 ROCKWALL, TX 75087 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILITATES (CIGNA) | $632 | $0 | $632 | 15.00% |
| K&S INSURANCE AGENCY3 | PO BOX 277 ROCKWALL, TX 75087 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILITATES (CIGNA) | $134 | $0 | $134 | 14.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BERKLEY LIFE AND HEALTH EIN 91-6034263 ADMIN | Plan Administrator Service code 14 | — | $205K |
| K&S INSURANCE AGENCY AGENT | Insurance agents and brokers Service code 22 | PO BOX277 ROCKWALL, TX 75087 | $34K |
| BEVCAP MANAGEMENT, LLC EIN 26-1870141 AGENT | Insurance agents and brokers Service code 22 | — | $24K |
| BEVCAP HEALTH CAPITVE - NC EIN 26-1870141 ADMIN | Plan Administrator Service code 14 | — | $22K |
| BOON CHAPMAN - LTD EIN 74-2305238 ADMIN | Plan Administrator; Claims processing Service code 12 | — | $19K |
| AETNA - PPO EIN 06-6033492 ADMIN | Insurance services Service code 23 | — | $13K |
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 | 325 | 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) | 325 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILITATES (CIGNA) | 166 | $50K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 165 | $7K |
| Life insurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILITATES (CIGNA) | 282 | $14K |
| Short-term disability | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILITATES (CIGNA) | 56 | $12K |
| Long-term disability | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILITATES (CIGNA) | 44 | $4K |
| Stop-loss / reinsurancereinsurance | BERKLEY LIFE & HEALTH INSURANCE COMPANY | 115 | $204K |
| Other | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILITATES (CIGNA) | 282 | $895 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 282 | — |
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.