| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN L. WORTHAM & SON, LP | PO BOX 301598 DALLAS, TX 75303 | EYEMED VISION CARE | $57 | — | $57 | 5.42% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN L. WORTHAM & SON, LP | PO BOX 301598 DALLAS, TX 75303 | EYEMED VISION CARE | $0 | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK BLUESHIELD EIN 23-1294723 NONE | Other fees; Direct payment from the plan; Claims processing Service code 12 | — | $561K |
| UNITED HEALTHCARE INSURANCE COMPANY EIN 41-1289245 NONE | Other services; Direct payment from the plan; Claims processing Service code 12 | — | $190K |
| PRICEWATERHOUSECOOPERS LLP EIN 13-4008324 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $108K |
| FIDELITY EIN 04-2647786 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Recordkeeping fees; Direct payment from the plan Service code 15 | — | $77K |
| WELLS FARGO EIN 94-1347393 NONE | Trustee (bank, trust company, or similar financial institution); Investment management; Direct payment from the plan; Trustee (directed); Distribution (12b-1) fees; Investment management fees paid indirectly by plan Service code 21 | — | $7K |
| BUCK CONSULTANTS EIN 13-3954297 NONE | Consulting (general); Direct payment from the plan; Consulting fees Service code 16 | — | $6K |
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 | 1,077 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,077 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision(2 contracts) | EYEMED VISION CARE | 20 | $1K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 20 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.