| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAYS COMPANIES, INC.3 Filed as: THE HAYS BENEFITS GROUP OF WI LLC | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | UNITED OF OMAHA LIFE INSURANCE | $3K | $823 | $3K | 15.74% |
| THE HORTON GROUP3 | 10320 ORLAND PARKWAY ORLAND PARK, IL 60467 | UNITED OF OMAHA LIFE INSURANCE | $338 | — | $338 | 1.57% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS BENEFITS GROUP OF WI | 1200 N MAYFAIR RD STE100 MILWAUKEE, WI 53226 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $451 | $2K | 15.97% |
| THE HORTON GROUP3 | 10320 ORLLAND PARKWAY ORLAND PARK, IL 60467 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $319 | $0 | $319 | 2.35% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS BENEFITS GROUP OF WI | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $435 | $2K | 11.78% |
| THE HORTON GROUP3 | 10320 ORLAND PARKWAY ORLAND PARK, IL 60467 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $203 | $0 | $203 | 1.56% |
| HAYS COMPANIES, INC.3 Filed as: HAYS GROUP OF WISCONSIN | 1200 N MAYFAIR RD STE 100 MILWAUKEE, WI 53226 | NATIONAL VISION ADMINISTRATOR | $619 | $0 | $619 | 7.53% |
| THE HORTON GROUP3 | 10320 ORLAND PARKWAY ORLAND PARK, IL 60467 | NATIONAL VISION ADMINISTRATOR | $203 | — | $203 | 2.47% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX INC. EIN 33-0441200 PHARMACY BENEFIT MANAGER | Direct payment from the plan; Float revenue; Claims processing; Other fees Service code 12 | — | $116K |
| UMR EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $101K |
| HAYS COMPANIES EIN 41-1932108 BROKER | Other commissions Service code 55 | — | $23K |
| THE HORTON GROUP EIN 36-3672171 BROKER | Other commissions Service code 55 | — | $7K |
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 | 107 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | NATIONAL VISION ADMINISTRATOR | 65 | $8K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 107 | $27K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE | 107 | $22K |
| Other(4 contracts, 3 carriers) | QBE INSURANCE CORPORATION | 107 | $272K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 107 | — |
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.