| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UPSHAW INSURANCE AGENCY INC.3 Filed as: UPSHAW INSURANCE AGENCY | PO BOX 1299 AMARILLO, TX 79101 | AMERITAS | $7K | $699 | $8K | 11.02% |
| UPSHAW INSURANCE AGENCY INC.3 Filed as: UPSHAW INSURANCE AGENCY | PO BOX 1299 AMARILLO, TX 79101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $912 | $6K | 17.92% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| IMS MARKETING, INC. EIN 75-2355889 THIRD PARTY ADMINISTRATOR | Plan Administrator; Claims processing Service code 12 | 731 N TAYLOR ST AMARILLO, TX 79107 | $57K |
| UPSHAW INSURANCE AGENCY EIN 75-2532190 INSURANCE AGENT | Insurance agents and brokers Service code 22 | PO BOX 1299 AMARILLO, TX 79101 | $29K |
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 | 85 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 85 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | INTERNATIONAL SPECIALTY UNDERWRITERS, INC. | 85 | $355K |
| Dental | AMERITAS | 85 | $69K |
| Vision | AMERITAS | 85 | $69K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 85 | $31K |
| Prescription drug | INTERNATIONAL SPECIALTY UNDERWRITERS, INC. | 85 | $355K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 85 | $39K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 85 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.