| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEVIN HINES3 | P.O. BOX 421429 INDIANAPOLIS, IN 46241 | UNUM LIFE INSURANCE CO OF AMERICA | $5K | $0 | $5K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC EIN 33-0441200 PHARMACY BENEFIT MGMT | Other fees; Direct payment from the plan; Float revenue; Claims processing Service code 12 | — | $1.4M |
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | P.O. BOX 1087 WAUSAU, WI 544021087 | $372K |
| SUN LIFE ASSURANCE CO OF CANADA EIN 38-1082080 ADMIN SERVICES-DENTAL | Other fees; Claims processing Service code 12 | 2323 GRAND BOULEVARD KANSAS CITY, MO 641082670 | $268K |
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 | 548 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 548 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Long-term disability | UNUM LIFE INSURANCE CO OF AMERICA | 551 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 551 | — |
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.