| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UPSHAW INSURANCE AGENCY INC.3 Filed as: UPSHAW INSURANCE AGENCY | PO BOX 1299 AMARILLO, TX 79105 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $14K | — | $14K | 20.00% |
| STEALTH PARTNER GROUP LLC3 Filed as: STEALTH PARTNER GROUP LLC SOUTHWEST | 18940 NORTH PIMA ROAD SUITE 210 SCOTTSDALE, AZ 85255 | HCC LIFE INSURANCE COMPANY | $652 | — | $652 | 5.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INSURANCE MANAGEMENT SERVICES EIN 75-2355889 THIRD PARTY ADMINISTRATOR | Plan Administrator; Claims processing Service code 12 | 731 N TAYLOR AMARILLO, TX 79107 | $572K |
| UPSHAW INSURANCE AGENCY EIN 75-2352190 INSURANCE AGENT | Insurance agents and brokers Service code 22 | PO BOX 1299 AMARILLO, TX 79105 | $31K |
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 | 100 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | INTERNATIONAL SPECIALTY UNDERWRITER INC | 100 | $226K |
| Life insurance | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 130 | $68K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 130 | $68K |
| Prescription drug | INTERNATIONAL SPECIALTY UNDERWRITER INC | 100 | $226K |
| Other | HCC LIFE INSURANCE COMPANY | 100 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 130 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.