| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFITS CONCEPTS AND SERVICES INC3 | 8 OLD GROVE LN ALTAMONTE SPRINGS, FL 32701 | SUN LIFE ASSURANCE COMPANY OF CANADA | $527 | — | $527 | 12.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FRESENIUS MEDICAL CARE NORTH EIN 46-1203188 NONE | Direct payment from the plan Service code 50 | — | $320K |
| UNIVERSITY OF CHICAGO MEDICAL EIN 36-3488183 NONE | Direct payment from the plan Service code 50 | — | $301K |
| THE COMMUNITY HOSPITAL EIN 35-1107009 NONE | Direct payment from the plan Service code 50 | — | $182K |
| NEOMEDICA MUNSTER EIN 46-2452682 NONE | Direct payment from the plan Service code 50 | — | $175K |
| OPTUMRX, INC. EIN 33-0441200 NONE | Direct payment from the plan; Claims processing; Float revenue; Other fees Service code 12 | — | $86K |
| UMR, INC. EIN 39-1995276 NONE | Claims processing Service code 12 | — | $61K |
| MACNEAL HOSPITAL EIN 62-1796152 NONE | Direct payment from the plan Service code 50 | — | $56K |
| SUMMIT ON SITE SOLUTIONS EIN 27-0199570 NONE | Direct payment from the plan Service code 50 | — | $40K |
| RUSH UNIVERSITY MEDICAL CENTER EIN 36-2174823 NONE | Direct payment from the plan Service code 50 | — | $36K |
| ST ALEXIUS MEDICAL CENTER EIN 36-4251846 NONE | Direct payment from the plan Service code 50 | — | $28K |
| RIVERSIDE MEDICAL CENTER EIN 36-2414944 NONE | Direct payment from the plan Service code 50 | — | $21K |
| UNIVERSITY OF CHICAGO EIN 36-2177139 NONE | Direct payment from the plan Service code 50 | — | $20K |
| OAKBROOK MEDICAL ASSOCIATES EIN 36-3899326 NONE | Direct payment from the plan Service code 50 | — | $19K |
| ALEXIAN BROTHERS MEDICAL CENTER EIN 36-2596381 NONE | Direct payment from the plan Service code 50 | — | $18K |
| NEPHRON DIALYSIS CENTER EIN 36-4277109 NONE | Direct payment from the plan Service code 50 | — | $16K |
| METROSOUTH MEDICAL CENTER EIN 45-4082512 NONE | Direct payment from the plan Service code 50 | — | $15K |
| LUTHERAN GENERAL HOSPITAL EIN 36-2169147 NONE | Direct payment from the plan Service code 50 | — | $15K |
| GRAND AVENUE SURGICAL EIN 36-4599318 NONE | Direct payment from the plan Service code 50 | — | $13K |
| SUNITI MEDICAL CORPORATION EIN 35-1529228 NONE | Direct payment from the plan Service code 50 | — | $12K |
| LITTLE COMPANY OF MARY HOSPITAL EIN 36-2246719 NONE | Direct payment from the plan Service code 50 | — | $11K |
| NEPHROLOGY ASSC NORTHERN INDIANA EIN 36-3683493 NONE | Direct payment from the plan Service code 50 | — | $11K |
| EXCEL THERAPY EIN 45-0568305 NONE | Direct payment from the plan Service code 50 | — | $8K |
| DUPAGE MEDICAL GROUP LTD EIN 36-2657618 NONE | Direct payment from the plan Service code 50 | — | $7K |
| FRANCISCAN ST MARGARET EIN 35-1835133 NONE | Direct payment from the plan Service code 50 | — | $7K |
| SWEDISH COVENANT HOSPITAL EIN 36-2179813 NONE | Direct payment from the plan Service code 50 | — | $7K |
| LAKE UROLOGY EIN 27-2064464 NONE | Direct payment from the plan Service code 50 | — | $7K |
| SILVER CROSS HOSPITAL EIN 36-2174832 NONE | Direct payment from the plan Service code 50 | — | $6K |
| PRESENCE SAINT JOSEPH CHICAGO EIN 36-2235165 NONE | Direct payment from the plan Service code 50 | — | $6K |
| PALOS COMMUNITY HOSPITAL EIN 36-2169179 NONE | Direct payment from the plan Service code 50 | — | $6K |
| PRONGER SMITH MEDICALCARE EIN 36-4121705 NONE | Direct payment from the plan Service code 50 | — | $6K |
| LOUIS A WEISS MEMORIAL EIN 62-1861142 NONE | Direct payment from the plan Service code 50 | — | $6K |
| ILLINOIS RETINA ASSOCIATES EIN 36-2970624 NONE | Direct payment from the plan Service code 50 | — | $5K |
| LABCORP OF AMERICA HOLDINGS EIN 13-3757370 NONE | Direct payment from the plan Service code 50 | — | $5K |
| HEART CARE CENTERS OF IL EIN 36-4148388 NONE | Direct payment from the plan Service code 50 | — | $5K |
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 | 120 | 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) | 120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 121 | $4K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 120 | $556K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 121 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 121 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.