| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURICA, INC.3 Filed as: INSURICA INSURANCE SERVICES, LLC | 1200 COTTONWOOD CREEK TRL CEDAR PARK, TX 78613 | PRINCIPAL LIFE INSURANCE | $9K | $148 | $10K | 10.16% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INSURANCE MANAGEMENT SERVICES EIN 75-2355889 THIRD PARTY ADMINISTRATOR | Plan Administrator; Claims processing Service code 12 | 731 N TAYLOR AMARILLO, TX 79107 | $66K |
| EHIM EIN 58-2422694 RX MANAGEMENT | Other services Service code 49 | 26711 NW HWY STE 400 SOUTHFIELD, MI 48033 | $9K |
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 | 113 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PAN AMERICAN LIFE INSURANCE COMPANY | 113 | $502K |
| Dental | PRINCIPAL LIFE INSURANCE | 245 | $94K |
| Vision | PRINCIPAL LIFE INSURANCE | 245 | $94K |
| Prescription drug | PAN AMERICAN LIFE INSURANCE COMPANY | 113 | $502K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 245 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.