| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OPTUMRX, INC.5 Filed as: OPTUMRX INC | 11000 OPTUM CIR EDEN PRAIRIE, MN 55344 | COMPANION LIFE INSURANCE COMPANY | — | $199K | $199K | 74.91% |
| UMR, INC.5 Filed as: UMR INC | PO BOX 1087 WAUSAU, WI 54402 | COMPANION LIFE INSURANCE COMPANY | — | $35K | $35K | 13.07% |
| INFINITY BENEFIT SOLUTIONS INC3 Filed as: INFINITY BENEFIT SOLUTIONS INC. | 1036 W JUNEAU AVE, STE 302 MILWAUKEE, WI 53233 | COMPANION LIFE INSURANCE COMPANY | $10K | — | $10K | 3.58% |
| COTTINGHAM & BUTLER3 | 800 MAIN ST DUBUQUE, IA 52001 | COMPANION LIFE INSURANCE COMPANY | $9K | — | $9K | 3.49% |
| COTTINGHAM & BUTLER3 | 800 MAIN ST DUBUQUE, IA 52001 | DELTA DENTAL OF WISCONSIN | $4K | — | $4K | 7.66% |
| COTTINGHAM & BUTLER3 | 800 MAIN ST DUBUQUE, IA 52001 | WYSSTA INSURANCE COMPANY INC | — | — | $0 | 0.00% |
| INFINITY BENEFIT SOLUTIONS INC3 Filed as: INFINITY BENEFIT SOLUTIONS INC. | 1036 W JUNEAU AVE, STE 302 MILWAUKEE, WI 53233 | WYSSTA INSURANCE COMPANY INC | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX INC EIN 33-0441200 PHARMACY BENEFIT MANAGER | Other fees; Claims processing; Direct payment from the plan; Float revenue Service code 12 | — | $199K |
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $35K |
| INFINITY BENEFIT SOLUTIONS INC. EIN 46-0991049 BROKER | Other commissions Service code 55 | — | $10K |
| COTTINGHAM & BUTLER EIN 42-0198040 BROKER | Other commissions Service code 55 | — | $9K |
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 | 67 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 67 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMPANION LIFE INSURANCE COMPANY | 53 | $266K |
| Dental | DELTA DENTAL OF WISCONSIN | 53 | $46K |
| Vision | WYSSTA INSURANCE COMPANY INC | 55 | $8K |
| Life insurance | COMPANION LIFE INSURANCE COMPANY | 53 | $266K |
| Prescription drug | COMPANION LIFE INSURANCE COMPANY | 53 | $266K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE COMPANY | 53 | $266K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 55 | — |
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.