| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURICA, INC.3 Filed as: INSURICA | 301 SOUTH POLK STREET, SUITE 600 AMARILLO, TX 79101 | BLUECROSS BLUESHIELD OF TEXAS | $4K | $0 | $4K | 0.64% |
| GALLAGHER BENEFIT SERVICES, INC.3 | UNKNOWN AMARILLO, TX 79109 | BLUECROSS BLUESHIELD OF TEXAS | $2K | — | $2K | 0.23% |
| INSURICA, INC.3 Filed as: INSURICA | 301 SOUTH POLK STREET, SUITE 600 AMARILLO, TX 79101 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $9K | $0 | $9K | 14.12% |
| DIANNE L MARTIN3 Filed as: DIANNE WALL INC | 4160 BUSINESS PARK DRIVE AMARILLO, TX 79109 | ASSURITY LIFE INSURANCE COMPANY | $2K | $0 | $2K | 5.87% |
| INSURICA, INC.3 Filed as: INSURICA | 301 SOUTH POLK STREET, SUITE 600 AMARILLO, TX 79101 | ASSURITY LIFE INSURANCE COMPANY | $2K | $0 | $2K | 4.43% |
| LOGAN T. TIFFANY3 | UNKNOWN AMARILLO, TX 79109 | ASSURITY LIFE INSURANCE COMPANY | $2K | $0 | $2K | 4.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | UNKNOWN AMARILLO, TX 79109 | ASSURITY LIFE INSURANCE COMPANY | $1K | $0 | $1K | 3.45% |
| CARTER-CRUTCHFIELD, INC.3 Filed as: CARTER-CRUTCHFIELD | UNKNOWN AMARILLO, TX 79109 | ASSURITY LIFE INSURANCE COMPANY | $705 | $0 | $705 | 1.74% |
| WORKSITE MARKETING CONCEPTS INC3 | UNKNOWN AMARILLO, TX 79109 | ASSURITY LIFE INSURANCE COMPANY | $173 | $0 | $173 | 0.43% |
| INSURICA, INC.3 Filed as: INSURICA | 301 SOUTH POLK STREET, SUITE 600 AMARILLO, TX 79101 | 5STAR LIFE INSURANCE COMPANY | $1K | $0 | $1K | 5.29% |
| DIANNE L MARTIN3 Filed as: DIANNE WALL INC | 4160 BUSINESS PARK DRIVE AMARILLO, TX 79109 | 5STAR LIFE INSURANCE COMPANY | $800 | $0 | $800 | 3.72% |
| JULIE L. HULSEY, LP3 Filed as: JULIE L. HULSEY LP | 6601 WEST INTERSTATE 40 AMARILLO, TX 79106 | 5STAR LIFE INSURANCE COMPANY | $276 | $0 | $276 | 1.28% |
| INSURICA, INC.3 Filed as: INSURICA | 301 SOUTH POLK STREET, SUITE 600 AMARILLO, TX 79101 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 20.00% |
No Schedule C service providers reported on this filing.
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 | 81 | 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) | 81 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF TEXAS | 190 | $704K |
| Vision | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 104 | $60K |
| Life insurance(3 contracts, 3 carriers) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 182 | $122K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 104 | $60K |
| Long-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 104 | $60K |
| Prescription drug | BLUECROSS BLUESHIELD OF TEXAS | 190 | $704K |
| Other(3 contracts, 3 carriers) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 182 | $109K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 190 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.