| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HOLMES MURPHY & ASSOCIATES3 Filed as: HOLMES MURPHY & ASSOCIATES INC | 5120 S SOLBERG AVE SIOUX FALLS, SD 57108 | DELTA DENTAL OF SOUTH DAKOTA | $1K | — | $1K | 2.28% |
| HOLMES MURPHY & ASSOCIATES3 Filed as: HOLMES MURPHY & ASSOCIATES INC | PO BOX 441 DES MOINES, IA 50302 | SUN LIFE ASSURANCE COMPANY OF CANADA | $1K | $53 | $1K | 9.71% |
| HOLMES MURPHY & ASSOCIATES3 Filed as: HOLMES MURPHY & ASSOCIATES INC | PO BOX 441 DES MOINES, IA 50302 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $923 | — | $923 | 9.77% |
| FLEXVISION3 | 15400 CALHOUN DR ROCKVILLE, MD 20855 | FIDELITY SECURITY LIFE INSURANCE COMPANY | — | $201 | $201 | 2.13% |
| AUDREY ANN JOHNSON3 | 7373 E DOUBLETREE RANCH 200 SCOTTSDALE, AZ 85258 | FIDELITY SECURITY LIFE INSURANCE COMPANY | — | $92 | $92 | 0.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX INC EIN 33-0441200 PHARMACY BENEFIT MGMT | Direct payment from the plan; Other fees; Claims processing; Float revenue Service code 12 | P O BOX 650629 DALLAS, TX 752650629 | $119K |
| UMR, INC. EIN 39-1995276 CLAIM PROCESSING | Claims processing Service code 12 | 11 SCOTT ST WAUSAU, WI 544034875 | $65K |
| HOLMES MURPHY & ASSOCIATES INC EIN 42-0985055 BROKER | Other commissions; Claims processing Service code 12 | 2727 GRAND PRAIRIE PARKWAY WAUKEE, IA 50263 | $29K |
| C2 CENTRIC LLC EIN 37-1667902 CLAIM PROCESSING | Claims processing Service code 12 | P O BOX 6824 GRAND RAPIDS, MI 49516 | $5 |
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 | 150 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 150 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF SOUTH DAKOTA | 145 | $62K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 150 | $9K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 103 | $15K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 103 | $15K |
| Stop-loss / reinsurancereinsurance | EAST COAST UNDERWRITERS | 70 | $236K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 103 | $1K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 150 | — |
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.