| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROGER BOUCHARD INSURANCE INC3 Filed as: ROGER BOUCHARD INSURANCE INC. | 101 STARCREST DRIVE CLEARWATER, FL 33765 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $4K | $4K | 1.31% |
| UMR, INC.3 | 11 SCOTT STREET, SUITE 100 WAUSAU, WI 54403 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $2K | $2K | 0.64% |
| ROGER BOUCHARD INSURANCE INC3 Filed as: ROGER BOUCHARD INS INC | 101 STARCREST DRIVE CLEARWATER, FL 33765 | GUARDIAN | $9K | — | $9K | 10.00% |
| ROGER BOUCHARD INSURANCE INC3 | 101 STARCREST DR CLEARWATER, FL 337653225 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 9.09% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 2.73% |
| ROGER BOUCHARD INSURANCE INC3 | 101 N STARCREST DR CLEARWATER, FL 33765 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 9.22% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 2.81% |
| ROGER BOUCHARD INSURANCE INC3 | 101 N STARCREST DR CLEARWATER, FL 33765 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $1K | $2K | 9.34% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $756 | $756 | 2.89% |
| 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 | — | $357K |
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $90K |
| ROGER BOUCHARD INS INC EIN 59-1117778 BROKER | Other commissions Service code 55 | — | $58K |
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 | 316 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 317 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN | 203 | $91K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 320 | $80K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 77 | $50K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 243 | $275K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 320 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 320 | — |
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.