| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 725 SOUTH FIGUEROA STREET 35TH FLOOR LOS ANGELES, CA 90017 | AETNA LIFE INSURANCE COMPANY | $103K | $5K | $108K | 2.36% |
| LOCKTON COMPANIES, LLC3 | 600 UNIVERSITY STREET, SUITE 1900 SEATTLE, WA 98101 | DELTA DENTAL OF WASHINGTON | $6K | $0 | $6K | 2.75% |
| LOCKTON COMPANIES, LLC3 | 600 UNIVERSITY STREET, SUITE 1900 SEATTLE, WA 98101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $17K | $0 | $17K | 13.47% |
| LOCKTON COMPANIES, LLC3 | PO BOX 650823 DALLAS, TX 75265 | UNUM INSURANCE COMPANY | $3K | $596 | $3K | 12.07% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS | 422 WAUPONSEE STREET MORRIS, IL 60450 | UNUM INSURANCE COMPANY | $3K | $565 | $3K | 11.04% |
| LOCKTON COMPANIES, LLC3 | 725 SOUTH FIGUEROA STREET 35TH FLOOR LOS ANGELES, CA 90017 | WILLAMETTE DENTAL OF WASHINGTON, INC. | $436 | $0 | $436 | 2.65% |
| LOCKTON COMPANIES, LLC3 | PO BOX 650823 DALLAS, TX 75265 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $103 | $2K | 28.63% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS | 422 WAUPONSEE STREET MORRIS, IL 60450 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 26.76% |
No Schedule C service providers reported on this filing.
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 | 279 | 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) | 279 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 403 | $4.6M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF WASHINGTON | 438 | $251K |
| Vision | AETNA LIFE INSURANCE COMPANY | 403 | $4.6M |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 284 | $132K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 284 | $126K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 284 | $126K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 284 | $155K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 438 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.