| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 | 100 OTTAWA AVE, SW GRAND RAPIDS, MI 49503 | BLUECROSS BLUESHIELD OF TEXAS | $34K | $632 | $35K | 2.87% |
| CENTERSTONE INSURANCE AND FINANCIAL3 | SERVICES 12404 PARK CENTRAL DRIVE, STE 400S DALLAS, TX 75251 | BLUECROSS BLUESHIELD OF TEXAS | $7K | $255 | $7K | 0.59% |
| INSURANCE & BONDS AGENCY OF TEXAS3 | 5057 KELLER SPRINGS ROAD SUITE 200 ADDISON, TX 75001 | GUARDIAN | $22K | $6K | $28K | 14.19% |
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 | 135 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 137 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TEXAS | 200 | $1.2M |
| Dental | GUARDIAN | 139 | $197K |
| Vision | GUARDIAN | 139 | $197K |
| Life insurance | GUARDIAN | 139 | $197K |
| Long-term disability | GUARDIAN | 139 | $197K |
| Other | GUARDIAN | 139 | $197K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 200 | — |
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.