| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FRED MAXWELL - ACIUS GROUP3 | SUITE 203, 2591 DALLAS PARKWAY FRISCO, TX 75034 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 0.27% |
| PAUL HICKS3 | 7038 GREATWOOD TRAILS DRIVE SUGAR LAND, TX 77479 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 0.10% |
| HARVARD PRINTING GROUP5 | 175 US HIGHWAY 46 WEST FAIRFIELD, NJ 070042327 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $89 | $89 | 0.01% |
| AXA ASSISTANCE, USA5 Filed as: AXA ASSISTANCE | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $79 | $79 | 0.01% |
| GATOR COMMUNICATIONS GROUP LLC5 | 175 US HIGHWAY 46 WEST FAIRFIELD, NJ 070042327 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $36 | $36 | 0.00% |
| FRED MAXWELL - ACIUS GROUP3 | SUITE 203, 2591 DALLAS PARKWAY FRISCO, TX 75034 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 2.27% |
| PAUL HICKS3 | 7038 GREATWOOD TRAILS DR SUGAR LAND, TX 77479 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 0.89% |
| HARVARD PRINTING GROUP5 | 175 US HIGHWAY 46 WEST FAIRFIELD, NJ 070042327 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $237 | $237 | 0.05% |
| AXA ASSISTANCE, USA5 Filed as: AXA ASSISTANCE,USA | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $209 | $209 | 0.05% |
| GATOR COMMUNICATIONS GROUP LLC5 | 175 US HIGHWAY 46 WEST FAIRFIELD, NJ 070042327 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $96 | $96 | 0.02% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN L WORTHAM & SON LLP | P.O.BOX 301598 HOUSTON, TX 75303 | AETNA LIFE INSURANCE COMPANY | — | $1K | $1K | 0.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE EIN 95-3939697 NONE | Contract Administrator Service code 13 | — | $620K |
| EMPYREAN EIN 20-3029813 NONE | Contract Administrator Service code 13 | — | $345K |
| VISION SERVICE PLAN EIN 06-1227840 NONE | Contract Administrator Service code 13 | — | $122K |
| AETNA DENTAL EIN 06-6033492 NONE | Contract Administrator Service code 13 | — | $75K |
| COMPASS EIN 76-0015205 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $44K |
| WELLS FARGO BANK EIN 94-2984229 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $26K |
| MCCONNELL & JONES LLP EIN 76-0488832 NONE | Accounting (including auditing) Service code 10 | — | $26K |
| ENNIS KNUPP & ASSOCIATES EIN 36-3109431 NONE | Investment advisory (plan) Service code 27 | — | $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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5,810 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 5,810 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AETNA LIFE INSURANCE COMPANY | 1,046 | $209K |
| Vision | VISION SERVICE PLAN | 3,577 | $591K |
| Life insurance(2 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,090 | $1.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,577 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.