| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN D PETERSON3 | 1930 CORNERSTONE PLACE DR KATY, TX 77450 | HUMANA INC | $10K | — | $10K | 5.80% |
| JOHN PETERSON3 | 1930 CORNERSTONE PLACE DR KATY, TX 774506704 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | — | $6K | 14.59% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | P.O. BOX 1087 WAUSAU, WI 554021087 | $279K |
| JOHN D PETERSON BROKER | Other commissions Service code 55 | 1930 CORNERSTONE PLACE DR KATY, TX 77450 | $48K |
| EYRING LEAVITT AND DRANEY PLLC EIN 26-1783184 INDEPENDENT AUDITOR | Accounting (including auditing) Service code 10 | 142 ELDRIDGE RD, STE C SUGAR LAND, TX 77478 | $8K |
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 | 366 | 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) | 366 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | HUMANA INC | 220 | $170K |
| Vision | HUMANA INC | 220 | $170K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 361 | $41K |
| Stop-loss / reinsurancereinsurance | QBE INSURANCE CORPORATION | 366 | $325K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 361 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 366 | — |
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.