| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OPTUM5 Filed as: OPTUM RX INC | 11000 OPTUM CIR EDEN PRAIRIE, MN 55344 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $108K | $108K | 32.72% |
| UMR, INC.5 Filed as: UMR INC | 115 W WAUSAU AVE WAUSAU, WI 54401 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $64K | $64K | 19.34% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER INS SRVCS INC | 800 MAIN ST DUBUQUE, IA 52001 | SUN LIFE ASSURANCE COMPANY OF CANADA | $21K | — | $21K | 6.34% |
| COTTINGHAM & BUTLER3 | 300 SECURITY BUILDING DUBUQUE, IA 52001 | DELTA DENTAL OF WISCONSIN | $4K | — | $4K | 7.37% |
| COTTINGHAM & BUTLER3 | 300 SECURITY BUILDING DUBUQUE, IA 52001 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | $2K | $7K | 17.75% |
| COTTINGHAM & BUTLER3 | 300 SECURITY BUILDING DUBUQUE, IA 52001 | WYSSTA INSURANCE COMPANY INC | $611 | — | $611 | 8.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX INC EIN 33-0441200 PHARMACY BENEFIT MGMT | Direct payment from the plan; Other fees; Float revenue; Claims processing Service code 12 | 11000 OPTUM DR EDEN PRAIRIE, MN 55344 | $108K |
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | 115 W WAUSAU ST WAUSAU, WI 54401 | $64K |
| COTTINGHAM & BUTLER EIN 42-0198040 BROKER | Other commissions Service code 55 | 800 MAIN ST. DUBUQUE, IA 52001 | $21K |
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 | 69 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 70 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SUN LIFE ASSURANCE COMPANY OF CANADA | 51 | $329K |
| Dental | DELTA DENTAL OF WISCONSIN | 51 | $50K |
| Vision | WYSSTA INSURANCE COMPANY INC | 52 | $8K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 66 | $41K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 66 | $41K |
| Prescription drug | SUN LIFE ASSURANCE COMPANY OF CANADA | 51 | $329K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 51 | $329K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 66 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.