| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UMR, INC.3 Filed as: UMR INC | 11 SCOTT ST STE 100 WAUSAU, WI 54403 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $2K | $2K | 0.64% |
| OMS INSURANCE GROUP3 | PO BOX 2 LAKELAND, FL 33802 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 10.00% |
| OMS INSURANCE GROUP3 | PO BOX 2 LAKELAND, FL 33802 | SUN LIFE ASSURANCE COMPANY OF CANADA | $12K | — | $12K | 16.39% |
| OMS INSURANCE GROUP3 | 26 LAKE WIRE DR LAKELAND, FL 33815 | ADVANTICA INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX INC EIN 33-0441200 PHARMACY BENEFIT MANAGER | Direct payment from the plan; Other fees; Float revenue; Claims processing Service code 12 | — | $205K |
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $125K |
| OMS INSURANCE GROUP EIN 59-3757026 BROKER | Other commissions Service code 55 | PO BOX 2 LAKELAND, FL 33802 | $54K |
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 | 136 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 136 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 110 | $82K |
| Vision | ADVANTICA INSURANCE COMPANY | 136 | $12K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 130 | $72K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 130 | $72K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 130 | $72K |
| Stop-loss / reinsurancereinsurance(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 120 | $507K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 136 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.