| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT N CORRIGAN | — | HEALTH CARE SERVICE CORPORATION | — | $2K | $2K | 0.10% |
| HEFA OPERATING LLC3 Filed as: HEFA OPERATING, LLC | 101 SUMMIT AVE STE 600 FORT WORTH, TX 76102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $793 | $66 | $859 | 2.80% |
| UNIFIED EMPLOYEE BENEFITS3 | 2900 S 70TH ST, STE 300 LINCOLN, NE 68506 | TRANSAMERICA LIFE INSURANCE COMPANY | $7K | — | $7K | 28.24% |
| LMBC LI, LLC3 | 735 PLAZA BLVD, STE 100 COPPELL, TX 75019 | TRANSAMERICA LIFE INSURANCE COMPANY | $4K | — | $4K | 17.07% |
| LISA N. BATES3 Filed as: LISA N BATES | 6 BAYOU POINTE DRIVE HOUSTON, TX 77063 | TRANSAMERICA LIFE INSURANCE COMPANY | $3K | — | $3K | 13.63% |
| UNIFIED EMPLOYEE BENEFITS3 | 2900 S 70TH ST, STE 300 LINCOLN, NE 68506 | TRANSAMERICA LIFE INSURANCE COMPANY | $1K | — | $1K | 5.36% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PARKWAY, STE 1950 ATLANTA, GA 30339 | TRANSAMERICA LIFE INSURANCE COMPANY | $12 | — | $12 | 0.05% |
| UNIFIED EMPLOYEE BENEFITS3 | 2900 S 70TH ST, STE 300 LINCOLN, NE 68506 | TRANSAMERICA LIFE INSURANCE COMPANY | $5K | — | $5K | 23.84% |
| LMBC LI, LLC3 | 735 PLAZA BLVD, STE 100 COPPELL, TX 75019 | TRANSAMERICA LIFE INSURANCE COMPANY | $3K | — | $3K | 15.27% |
| LISA N. BATES3 Filed as: LISA N BATES | 6 BAYOU POINTE DRIVE HOUSTON, TX 77063 | TRANSAMERICA LIFE INSURANCE COMPANY | $3K | — | $3K | 11.86% |
| UNIFIED EMPLOYEE BENEFITS3 | 2900 S 70TH ST, STE 300 LINCOLN, NE 68506 | TRANSAMERICA LIFE INSURANCE COMPANY | $2K | — | $2K | 7.00% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PARKWAY, STE 1950 ATLANTA, GA 30339 | TRANSAMERICA LIFE INSURANCE COMPANY | $56 | — | $56 | 0.25% |
| RONNIE WAYNE HAMILTON3 Filed as: RONNIE W HAMILTON | 5825 NICHOLAS CIRCLE AMARILLO, TX 79109 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $206 | — | $206 | 2.93% |
| PETRANDO TEXAS FINANCIAL GROUP3 Filed as: PETRANDO NORTHWESTERN BENEFITS | STRATEGIC EMPLOYEE BENEFIT SRV FORT WORTH, TX 76102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $178 | — | $178 | 2.53% |
| WAYNE JAMES PITRIE3 | 9737 BEVLYN DR HOUSTON, TX 77025 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $147 | $12 | $159 | 2.26% |
| MICHAEL S DAVID3 | ONE IRST UNITED BANK PKWY AMARILLO, TX 79119 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $134 | — | $134 | 1.91% |
| JOE FERNANDEZ3 | 1201 ELM ST STE 4250 DALLAS, TX 75270 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $98 | $16 | $114 | 1.62% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH ST RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $40 | $20 | $60 | 0.85% |
| DARIN POTTS3 | 510 BERING DRIVE HOUSTON, TX 77057 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | $10 | $31 | 0.44% |
| DAVID EVANS3 | 2711 YORK CT SOUTHLAKE, TX 76092 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.44% |
| DAVID ALLEN NEAL3 | 6136 FRISCO SQUARE BLVD FRISCO, TX 75034 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | $2 | $16 | 0.23% |
| PREMIER WORKSITE SOLUTIONS INC3 | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $8 | $15 | 0.21% |
| MARCEL JAMES MUELLER3 | 6664 RICHMOND DRIVE FRISCO, TX 75035 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.17% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH CARE SERVICE CORPORATION EIN 36-1236610 INSURANCE PROVIDER | Other insurance fees and expenses; Insurance services Service code 23 | — | $105K |
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 | 183 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 183 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH CARE SERVICE CORPORATION | 456 | $1.7M |
| Dental | HEALTH CARE SERVICE CORPORATION | 456 | $1.7M |
| Life insurance(3 contracts, 3 carriers) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 193 | $83K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 193 | $45K |
| Prescription drug | HEALTH CARE SERVICE CORPORATION | 456 | $1.7M |
| Other(4 contracts, 3 carriers) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 498 | $123K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 498 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.