| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EBS INSURANCE BROKERS3 | 1 GATEWAY CTR STE 650 NEWTON, MA 02458 | BLUECROSS BLUESHIELD OF TEXAS | $98K | — | $98K | 4.15% |
| EBS INSURANCE BROKERS3 | 1 GATEWAY CTR STE 650 NEWTON, MA 02458 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $39K | — | $39K | 13.54% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVE STE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $273 | $273 | 0.10% |
| EBS INSURANCE BROKERS3 | 1 GATEWAY CENTER STE 650 NEWTON, MA 02458 | VISION SERVICE PLAN | $2K | — | $2K | 3.91% |
| THE ROEBUCK GROUP LLC4 | 4240 PORTSMOUTH BLVD STE 459 CHESAPEAKE, VA 23321 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $842 | — | $842 | 30.01% |
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 | 995 | 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) | 995 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TEXAS | 732 | $2.4M |
| Dental | BLUECROSS BLUESHIELD OF TEXAS | 732 | $2.4M |
| Vision | VISION SERVICE PLAN | 398 | $45K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,047 | $287K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,047 | $287K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,047 | $287K |
| Prescription drug | BLUECROSS BLUESHIELD OF TEXAS | 732 | $2.4M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,047 | $289K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,047 | — |
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.