Form 5500 · Employee benefit plan · FORT WORTH, TX
SELECT PLASTICS LLC
The filing calls this plan SELECT PLASTICS LLC HEALTH & WELFARE BENEFIT PLAN.
Public Form 5500 records show how SELECT PLASTICS LLC of FORT WORTH, TX, a professional services employer, structures its employee benefits. Its broker of record is ROACH HOWARD SMITH & BARTON INC.. Coverage is written through BLUECROSS BLUESHIELD OF TEXAS and 1 other carrier. The plan's most recent policy period ended in September.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 75-2692008 · plan 501 · plan year 2025, filed Apr 30, 2026
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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: death benefits.
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 BLUECROSS BLUESHIELD OF TEXAS, covers 257 people.
Reported premium across the insured contracts is $1,871,078, with $103,051 in disclosed broker commissions — about 5.5% of premium.
The most recent policy period ended in September, and the plan year ends September 30. Group contracts typically renew on that annual cycle.
ROACH HOWARD SMITH & BARTON INC. is the broker of record on all 2 contracts.
Two carriers split the book: BLUECROSS BLUESHIELD OF TEXAS and THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUECROSS BLUESHIELD OF TEXAS | Health | 257 | Oct 1, 2025 | $1,664,340 | $85,521 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental, Vision, Life, Disability | 124 | Oct 1, 2025 | $206,738 | $17,530 |
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.
Reported to OSHA
Reported to OSHA for 2025: 65 employees, 5 recordable cases, 0 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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