| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 601 NW LOOP 410, SUITE 325 SAN ANTONIO, TX 78216 | BLUE CROSS BLUE SHIELD OF TEXAS | $0 | $22K | $22K | 5.87% |
| 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 | 1.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF TEXAS EIN 36-1236610 NONE | Contract Administrator Service code 13 | — | $279K |
| RUSSELL INVESTMENTS TRUST COMPANY EIN 91-1116938 NONE | Investment management Service code 28 | — | $185K |
| WELLS FARGO BANK, N.A. EIN 94-1347393 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $10K |
| EXPRESS SCRIPTS EIN 43-1420563 NONE | Contract Administrator Service code 13 | — | $3K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 367 | Continuation coverage (COBRA, retiree health). |
| Beneficiaries receiving benefits | 64 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 431 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 496 | $187K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF TEXAS | 456 | $370K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 496 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.