| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN RISK MANAGEMENT, LLC3 Filed as: ADAMS INSURANCE SERVICES, INC | P.O. BOX 7011 HOUSTON, TX 77248 | UNITED HEALTHCARE INSURANCE COMPANY | $30K | $0 | $30K | 2.96% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: ADAMS RISK MANAGEMENT SERVICES LLC | P.O. BOX 7011 HOUSTON, TX 77248 | UNITED HEALTHCARE INSURANCE COMPANY | $18K | $0 | $18K | 1.82% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GROUP & PENSION ADMINISTRATIONS EIN 75-1617587 CLAIMS PROCESSOR | Claims processing; Contract Administrator Service code 12 | — | $24K |
| ADAMS INSURANCE SERVICE BROKER | Insurance agents and brokers Service code 22 | 427 W 20TH STREET #500 HOUSTON, TX 77008 | $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 | 288 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 288 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 288 | $1.0M |
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 288 | $1.0M |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 288 | $1.0M |
| Prescription drug | UNITED HEALTHCARE INSURANCE COMPANY | 288 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 288 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.