Form 5500 · Employee benefit plan · FORT WORTH, TX
PELOTON LAND SOLUTIONS, INC.
The filing calls this plan PELOTON LAND SOLUTIONS, INC. WRAP PLAN.
PELOTON LAND SOLUTIONS, INC. of FORT WORTH, TX is a 175-participant professional services employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is HIGGINBOTHAM INS AGENCY INC.. Coverage is written through HEALTH CARE SERVICE CORPORATION and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 27-1645426 · plan 502 · plan year 2023, filed Jul 15, 2024
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 2 insured contracts covering health, dental, vision, life and disability; the largest, with HEALTH CARE SERVICE CORPORATION, covers 329 people.
Reported premium across the insured contracts is $1,891,763, with $110,139 in disclosed broker commissions — about 5.8% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
HIGGINBOTHAM INS AGENCY INC. is the broker of record on all 2 contracts.
Two carriers split the book: HEALTH CARE SERVICE CORPORATION and DEARBORN LIFE INSURANCE COMPANY.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| HEALTH CARE SERVICE CORPORATION | Health, Dental | 329 | Jan 1, 2024 | $1,740,617 | $92,906 |
| DEARBORN LIFE INSURANCE COMPANY | Vision, Life, Disability | 156 | Jan 1, 2024 | $151,146 | $17,233 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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