| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURANCE MANAGEMENT SERVICES5 | 731 N TAYLOR AMARILLO, TX 79107 | UNITED HEALTHCARE UNSURANCE COMPANY | $960 | — | $960 | 10.00% |
| INSURANCE MANAGEMENT SERVICES5 | 731 N TAYLOR ST AMARILLO, TX 79107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $329 | — | $329 | 8.38% |
| UPSHAW INSURANCE AGENCY INC.3 Filed as: UPSHAW INSURANCE AGENCY | PO BOX 1299 AMARILLO, TX 79101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $329 | — | $329 | 8.38% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INSURANCE MANAGEMENT SERVICES EIN 75-2355889 THIRD PARTY ADMINISTRATOR | Claims processing; Plan Administrator Service code 12 | 731 N TAYLOR AMARILLO, TX 79107 | $61K |
| UPSHAW INSURANCE AGENCY EIN 75-2532190 INSURANCE AGENT | Insurance agents and brokers Service code 22 | 801 S FILLMORE STE 300 AMARILLO, TX 79101 | $30K |
| AMERICAN HEALTH HOLDING, INC. EIN 31-1368946 RX MANAGEMENT | Other services Service code 49 | P.O. BOX 360142 PITTSBURGH, PA 15250 | $5K |
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 | 79 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 79 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PAN AMERICAN LIFE INSURANCE COMPANY | 79 | $284K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 79 | $4K |
| Prescription drug | PAN AMERICAN LIFE INSURANCE COMPANY | 79 | $284K |
| Other(2 contracts, 2 carriers) | UNITED HEALTHCARE UNSURANCE COMPANY | 79 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 79 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.