| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UMR, INC.3 | 11 SCOTT STREET WAUSAU, WI 54403 | HCC LIFE | $449 | — | $449 | 0.31% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MCGOHAN BRABENDER, INC. | 3931 SOUTH DIXIE DRIVE DAYTON, OH 45439 | DELTA DENTAL OF OHIO | $1K | — | $1K | 2.01% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | POST OFFICE BOX 62889 VIRGINIA BEACH, VA 23466 | DELTA DENTAL OF OHIO | $589 | $202 | $791 | 1.36% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE | $1K | — | $1K | 8.38% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MCGOHAN BRABENDER, INC. | 3931 SOUTH DIXIE DRIVE DAYTON, OH 45439 | EYEMED VISION CARE | $237 | — | $237 | 1.68% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX EIN 33-0441200 PBM | Direct payment from the plan; Other fees; Claims processing; Float revenue Service code 12 | — | $543K |
| UMR EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $157K |
| MCGOHAN BRABENDER, INC. EIN 31-1191330 BROKER | Other commissions Service code 55 | — | $19K |
| USI EIN 13-3771734 BROKER | Other commissions Service code 55 | — | $11K |
| JAMES SCOTT & SONES EIN 54-0372970 BROKER | Other commissions Service code 55 | — | $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 | 190 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF OHIO | 262 | $58K |
| Vision | EYEMED VISION CARE | 190 | $14K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | ZURICH NORTH AMERICAN INSURANCE COMPANY | 190 | $386K |
| Other | HCC LIFE | 169 | $145K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 262 | — |
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."
No prospect flags tripped on this filing.