| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | C/O BANK OF AMERICA PO BOX 505115 ST. LOUIS, MO 63150 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $34K | $34K | 0.75% |
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY INC | 900 N MICHIGAN AVE 15TH FLOOR CHICAGO, IL 60611 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $102K | $3K | $105K | 2.49% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 444 W. 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | HARVARD PILGRIM HEALTH CARE | $36K | — | $36K | 1.69% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | C/O BANK OF AMERICA PO BOX 505115 ST. LOUIS, MO 63150 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $11K | $11K | 1.24% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | C/O BANK OF AMERICA PO BOX 505115 ST. LOUIS, MO 63150 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $4K | $4K | 1.53% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 444 W. 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | HARVARD PILGRIM HEALTH CARE | $5K | — | $5K | 3.01% |
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY INC | 900 N MICHIGAN AVE 15TH FLOOR CHICAGO, IL 60611 | EYEMED VISION CARE | $2K | — | $2K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS. CO. EIN 59-1031071 NONE | Contract Administrator; Claims processing; Non-monetary compensation; Participant communication; Other services; Named fiduciary; Direct payment from the plan; Float revenue Service code 12 | — | $52.7M |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIM ADMINISTRATOR | Non-monetary compensation; Other services; Float revenue; Participant communication; Contract Administrator; Direct payment from the plan; Named fiduciary; Claims processing Service code 12 | — | $800K |
| LOCKTON COMPANIES LLC EIN 20-3395470 ACTUARY | Consulting (general) Service code 16 | — | $152K |
| BUCK CONSULTANTS LLC EIN 13-3954297 ACTUARY | Consulting (general) Service code 16 | — | $84K |
| BANK OF NEW YORK MELON EIN 13-5160382 INVESTMENT SERVICES | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $53K |
| ADP, LLC EIN 22-1467904 TAX PREP | Accounting (including auditing) Service code 10 | — | $16K |
| HALEY & ASSOCIATES EIN 55-0810153 AUDIT | Accounting (including auditing) Service code 10 | — | $14K |
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 | 10,164 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 49 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 10,213 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(12 contracts, 7 carriers) | HMSA BLUE CROSS BLUE SHIELD OF HAWAII | 10,696 | $28.3M |
| Dental(7 contracts, 4 carriers) | AETNA LIFE INSURANCE CO | 18,356 | $24.6M |
| Vision(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 5,830 | $627K |
| Life insurance(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO | 18,356 | $6.5M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 10,188 | $923K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 10,696 | $4.5M |
| Other(6 contracts, 6 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 41,729 | $634K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 41,729 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.