| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UMR, INC.5 | P.O. BOX 1087 WAUSAU, WI 544021087 | UMR, INC | — | $123K | $123K | — |
| ROB WHITTINGTON3 | 4480 S SILVERMAPLE PLACE BOISE, ID 83709 | UMR, INC | — | $20K | $20K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| STANDARD SECURITY LIFE INS CO OF NY EIN 13-5679267 STOP LOSS CARRIER | Insurance services Service code 23 | 85 ALLEN ST SUITE 210 ROCHESTER, NY 146081856 | $193K |
| ROB WHITTINGTON EIN 56-4905182 BROKER | Insurance agents and brokers Service code 22 | 4480 S SILVERMAPLE PLACE BOISE, ID 83709 | $20K |
| ZERO COMMISSIONS ENTITY EIN 36-2739571 LIFE INSURANCE | Insurance services Service code 23 | 9700 HEALTH CARE LANE MINNETONKA, MN 55343 | $9K |
| OPTUMRX, INC EIN 33-0441200 PHARMACY BENEFITS | Insurance services Service code 23 | P.O. BOX 509075 SAN DIEGO, CA 92150 | $0 |
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 | 204 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 204 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UMR, INC | 204 | $0 |
| Stop-loss / reinsurancereinsurance | UMR, INC | 204 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 204 | — |
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.