| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UMR, INC.3 Filed as: UMR | 2700 MIDWEST DR. ONALASKA, WI 54650 | OPTUM / UNITED RESOURCE NETWORK | $1K | $0 | $1K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PHARMACY BENEFIT MGMT | Other fees; Claims processing; Float revenue; Direct payment from the plan Service code 12 | — | $365K |
| UMR EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $96K |
| AON CONSULTING EIN 22-2232264 INSURANCE AGENT OR BROKER | Other commissions Service code 55 | — | $33K |
| DELTA DENTAL EIN 39-6094742 CLAIMS PROCESSING/TPA | Contract Administrator Service code 13 | — | $8K |
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 | 288 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 294 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 333 | $67K |
| Long-term disability | RELIASTAR LIFE INSURANCE COMPANY | 333 | $67K |
| Other(2 contracts, 2 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 333 | $88K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 333 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.