| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DULEY BOLWAR & ASSOCIATES INC3 Filed as: DULEY BOLWAR PEDERSON | 14805 N 73RD STREET SCOTTSDALE, AZ 85260 | RELIASTAR LIFE INSURANCE COMPANY | $70K | — | $70K | 9.70% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAM INC | 897 12TH STREET HAMMONTON, NJ 08037 | RELIASTAR LIFE INSURANCE COMPANY | $20 | — | $20 | 0.00% |
| DULEY BOLWAR & ASSOCIATES INC3 Filed as: DULEY BOLWAR PEDERSON | 14805 N 73RD STREET SCOTTSDALE, AZ 85260 | AETNA LIFE INSURANCE COMPANY | $18K | — | $18K | 7.43% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX EIN 33-0441200 PHARMACY BENEFIT MGMT | Other fees; Claims processing; Direct payment from the plan; Float revenue Service code 12 | — | $3.8M |
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | PO BOX 1087 WAUSAU, WI 54402 | $984K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINSTRATOR | Contract Administrator Service code 13 | 2801 HOOVER ROAD STEVENS POINT, WI 54481 | $91K |
| OPTUMRX INC. | Direct payment from the plan; Claims processing; Other fees; Float revenue Service code 12 | — | $0 |
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 | 4,887 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,898 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | AETNA LIFE INSURANCE COMPANY | 2,811 | $241K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 5,071 | $718K |
| Long-term disability | RELIASTAR LIFE INSURANCE COMPANY | 5,071 | $718K |
| Stop-loss / reinsurancereinsurance | STANDARD SECURITY LIFE | 2,499 | $444K |
| Other | RELIASTAR LIFE INSURANCE COMPANY | 5,071 | $718K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,071 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.