| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEPHEN ERIC HEBERT3 | 1806 N. TRAVIS ST. LIBERTY, TX 77575 | BLUECROSS BLUESHIELD OF TEXAS | $45K | $2K | $47K | 2.01% |
| STEPHEN ERIC HEBERT3 | 1806 N. TRAVIS ST. LIBERTY, TX 77575 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 8.60% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF TEXAS EIN 36-1236610 CONTRACT | Claims processing; Contract Administrator Service code 12 | 1001 E. LOOKOUT DR. RICHARDSON, TX 75082 | $194K |
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 | 493 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 493 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TEXAS | 493 | $2.3M |
| Dental | BLUECROSS BLUESHIELD OF TEXAS | 493 | $2.3M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 252 | $98K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 252 | $98K |
| Prescription drug | BLUECROSS BLUESHIELD OF TEXAS | 493 | $2.3M |
| Stop-loss / reinsurancereinsurance | BLUECROSS BLUESHIELD OF TEXAS | 493 | $2.3M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 252 | $98K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 493 | — |
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.