| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NATIONAL UNDERWRITING SERVICES0 | 14893 S.H. 16 NORTH #1 HELOTES, TX 78023 | NATIONAL UNDERWRITING SERVICES | $28K | — | $28K | — |
| CROWN RISK MANAGEMENT, LLC3 Filed as: SOUTHWEST RISK MANAGEMENT LLC | 4801 E MCKELLIPS ROAD MESA, AZ 85215 | NATIONAL UNDERWRITING SERVICES | $1K | — | $1K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NATIONAL UNDERWRITING SERVICES EIN 76-0168793 STOP LOSS CARRIER | Other fees Service code 99 | 14893 S.H 16 NORTH #1 HELOTES, TX 78023 | $28K |
| TRANSWESTERN INSURANCE ADMIN CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | P.O BOX 9817 FRESNO, CA 93794 | $23K |
| SOUTHWEST RISK MANAGEMENT LLC EIN 01-0778573 BROKER | Insurance agents and brokers Service code 22 | 4801 E MCKELLIPS ROAD MESA, AZ 85215 | $12K |
| SMITH BOMAN & ASSOCIATES EIN 94-2911577 BROKER | Insurance agents and brokers Service code 22 | P.O BOX 45019 FRESNO, CA 93718 | $957 |
| PAYER COMPASS LLC CONTRACT PROVIDER | Other fees Service code 99 | 5800 GRANITE PARKWAY PLANO, TX 75024 | $600 |
| MULTIPLAN, INC CONTRACT PROVIDER | Other fees Service code 99 | P.O BOX 29380 NEW YORK, NY 10087 | $530 |
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 | 99 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 99 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | NATIONAL UNDERWRITING SERVICES | 99 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 99 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.