Form 5500 · Employee benefit plan · CARROLLTON, TX
CAPFORM, INC.
CAPFORM, INC. of CARROLLTON, TX files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is USI INSURANCE SERVICES SOUTHWEST. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 75-1677890 · plan 501 · as of Jul 2026
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Commission |
|---|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | Dental | 926 | December | $22,425 |
| DEARBORN LIFE INSURANCE COMPANY | Life, Disability | 148 | December | $14,644 |
Questions
Who is CAPFORM, INC.'s benefits broker?
Per its most recent Form 5500 Schedule A, CAPFORM, INC.'s broker of record is USI INSURANCE SERVICES SOUTHWEST.
What insurance carrier does CAPFORM, INC. use?
CAPFORM, INC.'s benefit plan is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES, among 2 disclosed carriers.
When does CAPFORM, INC.'s group plan renew?
The most recent Schedule A policy period for CAPFORM, INC. ended in December. Group plans typically renew on the same annual cycle.
Where does this data come from?
All figures are drawn from CAPFORM, INC.'s public Form 5500 filing with the U.S. Department of Labor (EFAST2). Form 5500 is a public record.