| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| IMS MARKETING, INC.5 | 731 N TAYLOR ST AMARILLO, TX 79107 | HCC LIFE INSURANCE COMPANY | — | $16K | $16K | 3.71% |
| IMS MARKETING, INC.5 | 731 N TAYLOR ST AMARILLO, TX 79107 | HCC LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| INSURICA, INC.3 Filed as: INSURICA | P.O. BOX 2169 AMARILLO, TX 79105 | SUNLIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 10.00% |
| IMS MARKETING, INC.5 | 731 N TAYLOR ST AMARILLO, TX 79107 | SUNLIFE ASSURANCE COMPANY OF CANADA | $1K | — | $1K | 9.99% |
| 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 | $54K |
| INSURICA EIN 46-4900562 INSURANCE AGENT | Insurance agents and brokers Service code 22 | P.O. BOX 2169 AMARILLO, TX 79105 | $20K |
| AMERICAN HEALTH HOLDING, INC. EIN 31-1368946 RX MANAGEMENT | Other services Service code 49 | P.O. BOX 360142 PITTSBURGH, PA 15250 | $6K |
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 | 110 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMPANY | 110 | $430K |
| Life insurance | SUNLIFE ASSURANCE COMPANY OF CANADA | 110 | $12K |
| Prescription drug | HCC LIFE INSURANCE COMPANY | 110 | $430K |
| Other(2 contracts, 2 carriers) | HCC LIFE INSURANCE COMPANY | 110 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 110 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.