| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING COMPANY | PO BOX 62949 VIRGINIA BEACH, VA 23466 | SUN LIFE ASSURANCE COMPANY OF CANADA | $19K | $5K | $23K | 10.69% |
| CAMPBELL GALT AND NEWLANDS, INC.3 Filed as: CAMPBELL GALT & NEWLANDS | 700 NE MULTNOMAH ST STE 1300 PORTLAND, OR 97232 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC EIN 33-0441200 PHARMACY BENEFIT MGMT | Other fees; Float revenue; Claims processing; Direct payment from the plan Service code 12 | — | $1.5M |
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $418K |
| KIBBLE & PRENTICE HOLDING CO EIN 91-1176315 BROKER | Other commissions Service code 55 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | $113K |
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 | 1,270 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 59 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,336 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BERKLEY ACCIDENT AND HEALTH INSURANCE CO | 1,452 | $694K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,201 | $217K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,201 | $217K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,201 | $217K |
| Stop-loss / reinsurancereinsurance | BERKLEY ACCIDENT AND HEALTH INSURANCE CO | 1,452 | $684K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,452 | — |
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.