| 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 | $484 | — | $484 | 11.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SWEDISH COVENANT HOSPITAL EIN 36-2179813 NONE | Direct payment from the plan Service code 50 | — | $127K |
| OPTUMRX, INC. EIN 33-0441200 NONE | Float revenue; Other fees; Claims processing; Direct payment from the plan Service code 12 | — | $104K |
| CHRIST HOSPITAL EIN 36-2169147 NONE | Direct payment from the plan Service code 50 | — | $57K |
| MAYO CLINIC HOSPITAL RST EIN 41-0944601 NONE | Direct payment from the plan Service code 50 | — | $42K |
| UMR, INC. EIN 39-1995276 NONE | Claims processing Service code 12 | — | $36K |
| RIVERSIDE MEDICAL CENTER EIN 36-2414944 NONE | Direct payment from the plan Service code 50 | — | $20K |
| MAYO CLINIC ROCHESTER EIN 41-6011702 NONE | Direct payment from the plan Service code 50 | — | $19K |
| ADVOCATE CHILDREN'S HOSPITAL EIN 36-2169147 NONE | Direct payment from the plan Service code 50 | — | $17K |
| COMMUNITY HOSPITAL, MUNSTER, IN EIN 35-1107009 NONE | Direct payment from the plan Service code 50 | — | $15K |
| PALOS COMMUNITY HOSPITAL EIN 36-2169179 NONE | Direct payment from the plan Service code 50 | — | $14K |
| FRANCSICAN HEALTH HAMMOND EIN 35-1835133 NONE | Direct payment from the plan Service code 50 | — | $14K |
| ADVENTIST HINSDALE HOSPITAL EIN 36-2276984 NONE | Direct payment from the plan Service code 50 | — | $13K |
| MERCY HOSPITAL MED EIN 36-2170152 NONE | Direct payment from the plan Service code 50 | — | $11K |
| NORTHSHORE UNIV HEALTHSYS EIN 36-2167060 NONE | Direct payment from the plan Service code 50 | — | $10K |
| NORWEGIAN AMERICAN HOSPITAL EIN 36-1564290 NONE | Direct payment from the plan Service code 50 | — | $10K |
| ADVENTIST LA GRANGE MEM. HOSPITAL EIN 37-1762682 NONE | Direct payment from the plan Service code 50 | — | $8K |
| NORTHSHORE UNIVERSITY HEALTHSY EIN 36-3738206 NONE | Direct payment from the plan Service code 50 | — | $7K |
| ELMHURST MEMORIAL HOSPITAL EIN 36-2167784 NONE | Direct payment from the plan Service code 50 | — | $6K |
| HOLY CROSS HOSPITAL EIN 36-2170133 NONE | Direct payment from the plan Service code 50 | — | $6K |
| UNIVERSITY OF ILLINOIS HOSPITAL EIN 37-6000511 NONE | Direct payment from the plan Service code 50 | — | $6K |
| SWEDISH COVENANT MEDICAL GROUP EIN 36-4073303 NONE | Direct payment from the plan Service code 50 | — | $6K |
| DUPAGE MEDICAL GROUP EIN 36-2657618 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 | 85 | 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) | 85 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 85 | $4K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 85 | $435K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 85 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 85 | — |
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.