| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UPSHAW INSURANCE AGENCY INC.3 Filed as: UPSHAW INSURANCE AGENCY INC | 801 S. FILLMORE ST. SUITE 300 AMARILLO, TX 79101 | SUN LIFE ASSURANCE COMPANY OF CANADA | $30K | $73K | $103K | 17.18% |
| UNITED BENEFITS ADVISORS INC3 Filed as: UNITED BENEFITS ADVISORS LLC | 280 E 96TH ST SUITE 250 INDIANAPOLIS, IN 46240 | SUN LIFE ASSURANCE COMPANY OF CANADA | $14K | — | $14K | 2.29% |
| STOP LOSS INSURANCE SERVICES, INC.3 Filed as: STOP LOSS COALITION SERVICES LLC | 7632 SW DURHAM RD SUITE 115 TIGARD, OR 97224 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 0.21% |
| UNITED BENEFITS ADVISORS INC3 | 10 WUNSHINE LN RED LION, PA 17356 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $1K | $1K | 0.19% |
| UPSHAW INSURANCE AGENCY INC.3 Filed as: UPSHAW INSURANCE AGENCY | P.O. BOX 1299 AMARILLO, TX 79105 | AMERITAS LIFE INSURANCE CORP | $34K | $5K | $38K | 11.44% |
| UPSHAW INSURANCE AGENCY INC.3 Filed as: UPSHAW INSURANCE AGENCY | P.O. BOX 1299 AMARILLO, TX 79105 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $19K | — | $19K | 15.00% |
| UPSHAW INSURANCE AGENCY INC.3 Filed as: UPSHAW INSURANCE AGENCY | P.O. BOX 1299 AMARILLO, TX 79105 | US FIRE INSURANCE COMPANY | $5K | — | $5K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MAXOR EIN 37-1692805 THIRD PARTY ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | P.O. BOX 15050 AMARILLO, TX 79105 | $95K |
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 | 384 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 384 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SUN LIFE ASSURANCE COMPANY OF CANADA | 384 | $598K |
| Dental | AMERITAS LIFE INSURANCE CORP | 792 | $336K |
| Vision | AMERITAS LIFE INSURANCE CORP | 792 | $336K |
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 384 | $124K |
| Long-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 384 | $124K |
| Prescription drug | SUN LIFE ASSURANCE COMPANY OF CANADA | 384 | $598K |
| Other(2 contracts, 2 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 384 | $170K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 792 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.