| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CENTERSTONE INSURANCE AND FINANCIAL3 | 5090 N 40TH ST STE 100 PHOENIX, AZ 85018 | RELIASTAR LIFE INSURANCE COMPANY | $0 | $62K | $62K | 5.00% |
| UMR, INC.3 Filed as: UMR INC | 11 SCOTT ST STE 100 WAUSAU, WI 54403 | RELIASTAR LIFE INSURANCE COMPANY | $0 | $36K | $36K | 2.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC EIN 33-0441200 PHARMACY BENEFIT MGT | Direct payment from the plan; Claims processing; Other fees; Float revenue Service code 12 | — | $3.2M |
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $553K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $46K |
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Contract Administrator; Claims processing Service code 12 | — | $6K |
| JAN STAGE USI INSURANCE INS AGENT OR BROKER | Insurance agents and brokers Service code 22 | PO BOX 937 APPLETON, WI 54912 | $521 |
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 | 1,084 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 19 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 655 | $127K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 2,593 | $738K |
| Short-term disability | RELIASTAR LIFE INSURANCE COMPANY | 2,593 | $738K |
| Long-term disability | RELIASTAR LIFE INSURANCE COMPANY | 2,593 | $738K |
| Other(2 contracts) | RELIASTAR LIFE INSURANCE COMPANY | 2,593 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,593 | — |
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."
No prospect flags tripped on this filing.