| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALYEAN INSURANCE AGENCY3 Filed as: GALYEAN INSURANCE AGENCY INC | 227 CONNALLY STREET P O BOX 797 SULPHUR SPRINGS, TX 75482 | ZURICH NORTH AMERICAN INSURANCE COMPANY | $12K | — | $12K | 2.47% |
| GALYEAN INSURANCE AGENCY3 Filed as: GALYEAN INSURANCE AGENCY INC. | P O BOX 797 227 CONNALLY STREET SULPHUR SPRINGS, TX 75483 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | P O BOX 1087 WAUSAU, WI 54402 | $98K |
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 | 171 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 171 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ZURICH NORTH AMERICAN INSURANCE COMPANY | 148 | $472K |
| Dental | ZURICH NORTH AMERICAN INSURANCE COMPANY | 148 | $472K |
| Vision | ZURICH NORTH AMERICAN INSURANCE COMPANY | 148 | $472K |
| Life insurance(2 contracts, 2 carriers) | ZURICH NORTH AMERICAN INSURANCE COMPANY | 171 | $486K |
| Short-term disability | ZURICH NORTH AMERICAN INSURANCE COMPANY | 148 | $472K |
| Long-term disability | ZURICH NORTH AMERICAN INSURANCE COMPANY | 148 | $472K |
| Prescription drug | ZURICH NORTH AMERICAN INSURANCE COMPANY | 148 | $472K |
| Stop-loss / reinsurancereinsurance | ZURICH NORTH AMERICAN INSURANCE COMPANY | 148 | $472K |
| Other(2 contracts, 2 carriers) | ZURICH NORTH AMERICAN INSURANCE COMPANY | 171 | $486K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 171 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.