| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INS | P O BOX 28 DUBUQUE, IA 52004 | HARTFORD LIFE AND ACCIDENT | $11K | — | $11K | 10.24% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY AND ASSOC INS GROUP INC | 1 KELLY WAY SPARKS GLENCOE, MD 21152 | HARTFORD LIFE AND ACCIDENT | — | $4K | $4K | 3.70% |
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM AND BUTLER INS | P O BOX 28 DUBUQUE, IA 52004 | HARTFORD LIFE AND ACCIDENT L/T | $8K | — | $8K | 10.24% |
| INSGROUP INC3 Filed as: KELLY AND ASSOC INS GROUP INS | 1 KELLY WAY SPARKS GLENCOE, MD 21152 | HARTFORD LIFE AND ACCIDENT L/T | — | $3K | $3K | 3.82% |
| COTTINGHAM & BUTLER Filed as: COTTINGHAM & BUTLER INS | 800 MAIN STREET DUBUQUE, IA 52001 | RELIANCE STANDARD LIFE INSURANCE | $13K | — | $13K | 22.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX INC EIN 33-0441200 PHARMACY BENEFIT MANAGEME | Other fees; Direct payment from the plan; Claims processing; Float revenue Service code 12 | P O BOX 650334 DALLAS, TX 75265 | $124K |
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | PO BOX 30541 SALT LAKE CITY, UT 84130 | $34K |
| COTTINGHAM & BUTLER INS EIN 42-0198040 BROKER | Other commissions Service code 55 | 800 MAIN STREET DUBUQUE, IA 52001 | $17K |
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 | 201 | Currently employed and enrolled or eligible. |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 208 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ALABAMA | 102 | $404K |
| Dental | ANCHOR BENEFIT CONSULTING | 197 | $42K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE | 146 | $59K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 215 | $104K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT L/T | 145 | $74K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF ALABAMA | 102 | $404K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA/STOP LOSS | 0 | $249K |
| Other(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF ALABAMA | 102 | $412K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 215 | — |
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.