| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY3 Filed as: THE SEGAL COMPANY OF ARIZONA INC | 100 MONTGOMERY ST STE 500 SAN FRANCISCO, CA 94104 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 0.82% |
| THE SEGAL COMPANY3 Filed as: THE SEGAL COMPANY OF ARIZONA INC | 100 MONTGOMERY ST STE 500 SAN FRANCISCO, CA 94104 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX INC EIN 33-0441200 PHARMACY BENEFIT MGMT | Other fees; Float revenue; Claims processing; Direct payment from the plan Service code 12 | — | $903K |
| UMR INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | PO BOX 1187 WAUSAU, WI 54402 | $453K |
| OPTUMRX | Other fees; Float revenue; Direct payment from the plan; Claims processing Service code 12 | — | $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 | 1,223 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,227 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 4,375 | $496K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 4,375 | $496K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 4,375 | $512K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 4,375 | $496K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,375 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.