| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN RISK MANAGEMENT, LLC3 Filed as: HERITAGE RISK MANAGEMENT | P.O. BOX 64790 LUBBOCK, TX 79464 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $692 | — | $692 | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASSUMED BENEFITS ADMINISTRATION CONTRACT ADMINSTRATOR | Contract Administrator Service code 13 | 12221 MARRIOT DR STE 1800 DALLAS, TX 75251 | $60K |
| GLASS CONTROL, INC. EIN 75-2203190 EMPLOYER SPONSOR | Contract Administrator Service code 13 | P.O.BOX 64190 LUBBOCK, TX 79464 | $30K |
| BOLINGER,SEGARS,GILBERT & MOSS EIN 75-0882037 AUDITOR | Accounting (including auditing) Service code 10 | 8215 NASHVILLE AVE LUBBOCK, TX 79423 | $11K |
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 | 113 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $5K |
| Stop-loss / reinsurancereinsurance | GERBER LIFE INSURANCE COMPANY | 113 | $115K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 113 | — |
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.