| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | THREE MEMORIAL CITY 840 GESSNER RD. #600 HOUSTON, TX 77024 | BLUECROSS BLUESHIELD OF TEXAS | $50K | $935 | $51K | 3.68% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | 9811 KATY FWY #500 HOUSTON, TX 77024 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $2K | $8K | 7.80% |
| USI INSURANCE SERVICES LLC3 Filed as: USI SOUTHWEST, INC. | 9811 KATY FWY #500 HOUSTON, TX 77024 | METROPOLITAN LIFE INSURANCE COMPANY | — | $51 | $51 | 0.05% |
| PLUMHOFF AND ASSOCIATES, INC.3 Filed as: PLUMHOFF & ASSOCIATES, INC. | PO BOX 218060 HOUSTON, TX 77218 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 15.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES - LLC SOUTHW | PO BOX 61187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 4.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF TEXAS EIN 36-1236610 | Claims processing Service code 12 | 300 EAST RANDOLPH STREET CHICAGO, IL 60601 | $0 |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 | Insurance services Service code 23 | 200 PARK AVENUE NEW YORK, NY 10166 | $0 |
| UNITED OF OMAHA LIFE INSURANCE COMP EIN 47-0322111 | Insurance services Service code 23 | 3300 MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 | $0 |
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 | 250 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 250 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TEXAS | 250 | $1.4M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 250 | $103K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 250 | $103K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 183 | $44K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 183 | $44K |
| Prescription drug | BLUECROSS BLUESHIELD OF TEXAS | 250 | $1.4M |
| Stop-loss / reinsurancereinsurance | BLUECROSS BLUESHIELD OF TEXAS | 250 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.