| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | HCC LIFE INSURANCE COMPANY | $45K | — | $45K | 4.00% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $17K | $17K | 1.91% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 1.62% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 1.88% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $507 | $507 | 1.81% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF TEXAS EIN 36-1236610 ADMIN./CLAIMS PROCESSING | Claims processing; Contract Administrator Service code 12 | — | $478K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 DENTAL ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $51K |
| LOCKTON COMPANIES EIN 20-3354970 INSURANCE BROKER | Insurance agents and brokers Service code 22 | — | $18K |
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 | 1,340 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,351 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 981 | $134K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,526 | $882K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,340 | $204K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 1,069 | $1.1M |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,832 | $111K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,526 | — |
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.