| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTEGRATED BENEFITS SOLUTIONS, INC.4 Filed as: INTEGRATED HEALTH CONCEPTS | 10375 RICHMOND AVE STE 1890 HOUSTON, TX 77042 | EXPRESS SCRIPTS, INC | $0 | $2K | $2K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGGINBOTHAM INSURANCE AGENCY CONSULTING | Consulting (general) Service code 16 | 11700 KATY FWY STE 1100 HOUSTON, TX 77079 | $83K |
| UNITED HEALTHCARE SERVICE INC EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $59K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $6K |
| VISION SERVICE PLAN EIN 06-1227840 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $2K |
| CONEXIS EIN 20-0198855 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $983 |
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 | 105 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | STANDARD INSURANCE COMPANY | 105 | $61K |
| Short-term disability | STANDARD INSURANCE COMPANY | 105 | $50K |
| Long-term disability | STANDARD INSURANCE COMPANY | 105 | $32K |
| Prescription drug | EXPRESS SCRIPTS, INC | 312 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 312 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.