| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DULY-BOLWAR & ASSOCIATES, INC3 Filed as: DULY-BOLWAR & ASSOCIATES | 14805 N 73RD ST SCOTTSDALE, AZ 85260 | UNITED HEALTHCARE INSURANCE COMPANY | $138K | — | $138K | 14.78% |
| STOP LOSS INSURANCE SERVICES, INC.3 | 100 FRONT STREET SUITE 610 WORCESTER, MA 01608 | HCC LIFE INSURANCE COMPANY | $55K | — | $55K | 8.99% |
| DULY-BOLWAR & ASSOCIATES, INC3 Filed as: DULY-BOLWAR & ASSOCIATES | 14805 N 73RD ST SCOTTSDALE, AZ 85260 | AETNA LIFE INSURANCE COMPANY | $22K | — | $22K | 10.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PHARMACY BENEFIT MGMT | Claims processing; Direct payment from the plan; Float revenue; Other fees Service code 12 | — | $5.4M |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $1.3M |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATOR | Contract Administrator Service code 13 | 2801 HOOVER ROAD STEVENS POINT, WI 54481 | $75K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 INSURER | Other insurance fees and expenses Service code 73 | — | $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 | 4,573 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,584 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | AETNA LIFE INSURANCE COMPANY | 2,133 | $223K |
| Life insurance | UNITED HEALTHCARE INSURANCE COMPANY | 3,722 | $933K |
| Short-term disability | UNITED HEALTHCARE INSURANCE COMPANY | 3,722 | $933K |
| Long-term disability | UNITED HEALTHCARE INSURANCE COMPANY | 3,722 | $933K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 2,477 | $612K |
| Other | UNITED HEALTHCARE INSURANCE COMPANY | 3,722 | $933K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,722 | — |
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.