| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES REYNOLDS3 Filed as: JAMES D HUBBARD | 800 GESSNER ROAD, STE 300 HOUSTON, TX 77024 | BLUE CROSS & BLUE SHIELD OF TENNESSEE | $101K | $0 | $101K | 1.32% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY, INC. | PO BOX 908 FORT WORTH, TX 76101 | SUN LIFE ASSURANCE COMPANY OF CANADA | $9K | $20K | $29K | 6.61% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY, INC. | PO BOX 908 FORT WORTH, TX 76101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $34K | $0 | $34K | 9.73% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY, INC. | PO BOX 908 FORT WORTH, TX 76101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $23K | $0 | $23K | 10.32% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY, INC. | PO BOX 908 FORT WORTH, TX 76101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13K | $0 | $13K | 10.00% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY, INC. | PO BOX 908 FORT WORTH, TX 76101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $11K | $0 | $11K | 10.00% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFITS ADMIN, INC. | 101 S GARLAND AVE, STE 203 ORLANDO, FL 32801 | METROPOLITAN LIFE INSURANCE COMPANY | $164 | $0 | $164 | 0.44% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFITS ADMIN, INC. | 101 S GARLAND AVE, STE 203 ORLANDO, FL 32801 | METROPOLITAN LIFE INSURANCE COMPANY | $132 | $0 | $132 | 0.44% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFITS ADMIN, INC. | 101 S GARLAND AVE, STE 203 ORLANDO, FL 32801 | METROPOLITAN LIFE INSURANCE COMPANY | $119 | $0 | $119 | 0.43% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY, INC. | PO BOX 908 FORT WORTH, TX 76101 | METROPOLITAN GENERAL INSURANCE COMPANY | $3K | $195 | $3K | 11.63% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY, INC. | PO BOX 908 FORT WORTH, TX 76101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $0 | $2K | 10.00% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY, INC. | PO BOX 908 FORT WORTH, TX 76101 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $0 | $1K | 10.00% |
| HIGGINBOTHAM INS AGENCY INC3 Filed as: HIGGINBOTHAM INSURANCE AGENCY, INC. | PO BOX 908 FORT WORTH, TX 76101 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $919 | $0 | $919 | 9.07% |
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 | 1,394 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,398 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS & BLUE SHIELD OF TENNESSEE | 1,835 | $7.6M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 745 | $440K |
| Vision | BLUE CROSS & BLUE SHIELD OF TENNESSEE | 1,835 | $7.6M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $106K |
| Short-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $368K |
| Long-term disability(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $359K |
| Other(7 contracts, 4 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 393 | $254K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,835 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.