| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: GBS BENEFITS / GORDON BROWN | 465 SOUTH 400 EAST SUITE 300 SALT LAKE CITY, UT 84111 | EDUCATORS MUTUAL PLANS LIFE, ACCIDENT AND HEALTH, INC. | $5K | — | $5K | 7.00% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS BENEFITS INSURANCE AGENCY | 465 SOUTH 400 EAST SUITE 300 SALT LAKE CITY, UT 84111 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 5.25% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $36 | $36 | 0.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC EIN 33-0441200 PHARMACY BENEFIT MANAGEME | Direct payment from the plan; Claims processing; Float revenue; Other fees Service code 12 | — | $124K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $84K |
| GBS BENEFIT, INC. EIN 87-0680571 BROKER | Other commissions Service code 55 | — | $22K |
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 | 111 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UMR, INC. | 107 | $253K |
| Dental(2 contracts, 2 carriers) | UMR, INC. | 286 | $324K |
| Vision | UMR, INC. | 107 | $253K |
| Life insurance | UMR, INC. | 107 | $253K |
| Short-term disability | UMR, INC. | 107 | $253K |
| Long-term disability | UMR, INC. | 107 | $253K |
| Prescription drug | UMR, INC. | 107 | $253K |
| Stop-loss / reinsurancereinsurance | UMR, INC. | 107 | $253K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 286 | — |
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.