| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE BOON INSURANCE AGENCY3 Filed as: THE BOON INSURANCE AGENCY INC. | 6300 BRIDGEPOINT PARKWAY, BLDG 3 SUITE 500 AUSTIN, TX 78730 | TRANSAMERICA | $123K | $0 | $123K | 17.00% |
| FLOOD & PETERSON BENEFITS LLC3 Filed as: FLOOD & PETERSON BENEFITS | PO BOX 578 GREELY, CO 80632 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $88K | $0 | $88K | 20.00% |
| FLOOD & PETERSON BENEFITS LLC3 Filed as: FLOOD & PETERSON BENEFITS | PO BOX 578 GREELY, CO 80632 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $63K | $0 | $63K | 14.94% |
| FLOOD & PETERSON BENEFITS LLC3 Filed as: FLOOD & PETERSON BENEFITS | PO BOX 578 GREELY, CO 80632 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $0 | $8K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 NONE | Float revenue; Other services; Claims processing; Non-monetary compensation; Named fiduciary; Direct payment from the plan; Contract Administrator; Participant communication Service code 12 | P.O. BOX 5200 SCRANTON, PA 18505 | $1.1M |
| BOON ADMINSTRATIVE SERVICES, INC. EIN 33-0449333 NONE | Contract Administrator Service code 13 | 6300 BRIDGEPORT PARKWAY BUILDING 3, SUITE 500 AUSTIN, TX 78730 | $402K |
| FLOOD & PETERSON INSURANCE, INC. EIN 20-0899501 NONE | Insurance agents and brokers Service code 22 | 4687 WEST 18TH STREET GREELEY, CO 80634 | $70K |
| HOLTZMAN PARTNERS, LLP EIN 74-3121060 NONE | Accounting (including auditing) Service code 10 | 1710 WEST SIXTH STREET AUSTIN, TX 78703 | $16K |
| COMERICA EIN 38-1998421 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | COMERICA BANK TOWER 1717 MAIN STREET DALLAS, TX 75201 | $6K |
| BOON ADMINISTRATIVE SERVICES, INC. | Float revenue Service code 62 | — | $0 |
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 | 2,171 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 27 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,198 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 5,449 | $1.9M |
| Life insurance(2 contracts, 2 carriers) | TRANSAMERICA | 1,759 | $1.1M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 121 | $15K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,774 | $440K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 5,449 | $1.9M |
| Other(2 contracts, 2 carriers) | TRANSAMERICA | 1,759 | $780K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,449 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.