| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DULY-BOLWAR & ASSOCIATES, INC3 Filed as: DULY BULWAR PEDERSON | 14805 N 73RD STREET SCOTTSDALE, AZ 85260 | UNITED HEALTHCARE INSURANCE COMPANY | $126K | — | $126K | 14.54% |
| STOP LOSS INSURANCE SERVICES, INC.3 | 100 FRONT STREET SUITE 610 WORCESTER, MA 01608 | HCC LIFE INSURANCE COMPANY | $56K | — | $56K | 9.74% |
| HEALTH BENEFIT SOLUTIONS INSURANCE3 Filed as: HEALTH BENEFIT SOLUTIONS, LLC | 18940 NORTH PIMA ROAD SUITE 210 SCOTTSDALE, AZ 85255 | HCC LIFE INSURANCE COMPANY | $80 | — | $80 | 0.01% |
| DULY-BOLWAR & ASSOCIATES, INC3 Filed as: DULY BULWAR PEDERSON | 14805 N 73RD STREET SCOTTSDALE, AZ 85260 | UNITED HEALTHCARE INSURANCE COMPANY | $15K | — | $15K | 7.67% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PHARMACY BENEFIT MGMT | Direct payment from the plan; Claims processing; Other fees; Float revenue Service code 12 | — | $5.3M |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $1.5M |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINSTRATOR | Contract Administrator Service code 13 | — | $84K |
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 | 4,892 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,905 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 2,388 | $196K |
| Life insurance | UNITED HEALTHCARE INSURANCE COMPANY | 4,223 | $868K |
| Short-term disability | UNITED HEALTHCARE INSURANCE COMPANY | 4,223 | $868K |
| Long-term disability | UNITED HEALTHCARE INSURANCE COMPANY | 4,223 | $868K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 2,793 | $575K |
| Other | UNITED HEALTHCARE INSURANCE COMPANY | 4,223 | $868K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,223 | — |
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.