| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN L WORTHAM & SON LLP | PO BOX 301598 DALLAS, TX 75303 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 1.05% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 0.73% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN L WORTHAM & SON LLP | PO BOX 301598 DALLAS, TX 75303 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 2.54% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 0.73% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN L WORTHAM & SON LLP | PO BOX 301598 DALLAS, TX 75303 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 1.63% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 1.24% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: ARTHUR J GALLAGHER & CO | 601 NW LOOP 410, SUITE 325 SAN ANTONIO, TX 78216 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA | $173 | — | $173 | 15.04% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: REUBEN WARNER ASSOC INC | 1655 RICHMOND AVE STATEN ISLAND, NY 10314 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA | — | $173 | $173 | 15.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CONEXIS EIN 20-0198855 NONE | Plan Administrator Service code 14 | — | $19K |
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 | 1,072 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 20 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,092 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 1,495 | $120K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,986 | $756K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,066 | $124K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,066 | $302K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,986 | $757K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,986 | — |
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.