| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES T. BARDIN3 | 6820 W. LINEBAUGH AVE., STE 101 TAMPA, FL 336254951 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 7.50% |
| ANGUS WILLIAMS3 | 4902 BAYSHORE BLVD., APT. 714 TAMPA, FL 336113866 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 7.50% |
| 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 | 11000 OPTUM CIRCLE EDEN PRAIRIE, MN 55344 | $581K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | 115 W WAUSAU AVE. WAUSAU, WI 544012875 | $104K |
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 | 254 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 262 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SYMETRA LIFE INSURANCE COMPANY | 254 | $465K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 271 | $183K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 271 | $151K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 254 | $465K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 271 | $151K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 271 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.