| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 200 GALLERIA PARKWAY STE 1950 ATLANTA, GA 30339 | UNUM LIFE INSURANCE COMPANY | $4K | $2K | $5K | 5.01% |
| DIETZ & CABALLERO INC3 | 5441 SW MACADAM AVE STE 301 PORTLAND, OR 97239 | UNUM LIFE INSURANCE COMPANY | $5K | — | $5K | 4.41% |
| DIETZ & CABALLERO INC3 | 5441 SW MACADAM AVE, STE 301 PORTLAND, OR 97239 | UNUM LIFE INSURANCE COMPANY | $11K | — | $11K | 15.00% |
| DIETZ & CABALLERO INC3 | 811 SW 6TH AVENUE, SUITE 1000 PORTLAND, OR 97204 | UNITED HEALTHCARE INSURANCE CO | $2K | — | $2K | 9.11% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE | 200 GALLERIA PARKWAY STE 1950 ATLANTA, GA 30339 | UNITED HEALTHCARE INSURANCE CO | $183 | — | $183 | 1.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PHARMACY BENEFIT MGMT | Direct payment from the plan; Claims processing; Float revenue; Other fees Service code 12 | — | $643K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $157K |
| DIETZ & CABALLERO, INC EIN 47-4957240 BROKER | Other commissions Service code 55 | 811 SW 6TH AVE, STE 1000 PORTLAND, OR 97204 | $22K |
| DIGITAL INSURANCE INC EIN 58-2522668 BROKER | Other commissions Service code 55 | 200 GALLERIA PARKWAY ATLANTA, GA 30339 | $2K |
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 | 209 | 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. |
| Total participants (= "Plan participants" tile) | 209 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE CO | 103 | $17K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY | 209 | $183K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY | 209 | $109K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 209 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.