| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MC & H LIFE AGENCY INC3 Filed as: MC & H LIFE AGENCY, INC. | PO BOX 610789 DALLAS, TX 752610789 | BLUECROSS BLUESHIELD OF TEXAS | $12K | — | $12K | 0.10% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MHBT INC, | 8144 WALNUT HILL LN 16TH FLOOR DALLAS, TX 75231 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $7K | $7K | 2.43% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MHBT INC. | 8144 WALNUT HILL LN 16TH FLOOR DALLAS, TX 75231 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $5K | $5K | 2.41% |
| EDISON, DARRELL, LAWAYNE3 Filed as: EDISON, DARELL, LAWAYNE | 246 INVERNESS CTR DR. BIRMINGHAM, AL 35242 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | — | $9K | 7.04% |
| MMA DALLAS-WALNUT HILL3 | 8144 WALNUT HILL LN. 16TH FLOOR DALLAS, TX 75261 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $298 | $7K | 5.28% |
| WORKSITE BENEFITS GROUP INC3 Filed as: WORKSITE BENEFITS SERVICES, INC. | 246 INVERNESS CENTER DR BIRMINGHAM, AL 35242 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $554 | $554 | 0.44% |
| EDISON, DARRELL, LAWAYNE3 Filed as: EDISON, DARELL, LAWAYNE | 246 INVERNESS CTR DR. BIRMINGHAM, AL 35242 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 4.36% |
| MMA DALLAS-WALNUT HILL3 | 8144 WALNUT HILL LN 16TH FLOOR DALLAS, TX 75261 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 2.90% |
| C2 CENTRIC LLC3 | PO BOX 6824 GRAND RAPIDS, MI 49516 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $28 | $28 | 0.03% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MHBT INC | 8144 WALNUT HILL LN 16TH FLOOR DALLAS, TX 75231 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 2.40% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MHBT INC | 8144 WALNUT HILL LN 16TH FLOOR DALLAS, TX 75231 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $662 | $662 | 2.35% |
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 | 692 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 215 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 907 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF TEXAS | 2,330 | $17.7M |
| Dental(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF TEXAS | 2,330 | $13.5M |
| Vision | VISION SERVICE PLAN | 317 | $38K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 692 | $279K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 692 | $65K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 692 | $187K |
| Prescription drug | BLUECROSS BLUESHIELD OF TEXAS | 2,330 | $13.1M |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 692 | $241K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,330 | — |
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.