| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD 5TH FLOOR ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $231 | — | $231 | 5.58% |
| BENEFIT CONCEPTS AND SERVICES INC3 | 8 OLD GROVE LN ALTAMONTE SPRINGS, FL 32701 | SUN LIFE ASSURANCE COMPANY OF CANADA | $219 | — | $219 | 5.29% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX, INC EIN 33-0441200 PHARMACY BENEFIT MANAGEM | Other fees; Float revenue; Claims processing; Direct payment from the plan Service code 12 | — | $107K |
| OSF LITTLE COMPANY OF MARY MED EIN 37-0813229 NONE | Direct payment from the plan Service code 50 | — | $82K |
| NORTHWESTERN MEM HOSP EIN 37-0960170 NONE | Direct payment from the plan Service code 50 | — | $65K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $62K |
| LOYOLA UNIVERSITY MED CT EIN 36-4015560 NONE | Direct payment from the plan Service code 50 | — | $36K |
| ADVOCATE ILLINOIS MASONIC EIN 36-3196629 NONE | Direct payment from the plan Service code 50 | — | $33K |
| PRESENCE SAINTS MARY AND ELIZA EIN 36-2235165 NONE | Direct payment from the plan Service code 50 | — | $30K |
| CENTRAL NURSING HOME EIN 47-2035674 NONE | Direct payment from the plan Service code 50 | — | $28K |
| THE COMMUNITY HOSPITAL EIN 35-1107009 NONE | Direct payment from the plan Service code 50 | — | $24K |
| UNIVERSITY OF CHICAGO MEDICAL EIN 36-3488183 NONE | Direct payment from the plan Service code 50 | — | $23K |
| FRANCISCAN HEALTH OLYMPIA FIEL EIN 36-2167869 NONE | Direct payment from the plan Service code 50 | — | $20K |
| PRESENCE SAINT FRANCIS HOSPITAL EIN 36-2235165 NONE | Direct payment from the plan Service code 50 | — | $12K |
| DUPAGE MEDICAL GROUP LTD EIN 36-2657618 NONE | Direct payment from the plan Service code 50 | — | $10K |
| SWEDISH HOSPITAL EIN 36-2179813 NONE | Direct payment from the plan Service code 50 | — | $9K |
| ERIE FAMILY HEALTH CTR EIN 36-3088628 NONE | Direct payment from the plan Service code 50 | — | $8K |
| MACNEAL HOSPITAL EIN 36-3332852 NONE | Direct payment from the plan Service code 50 | — | $8K |
| MIDWEST PULMONARY AND CRITICAL EIN 35-2563749 NONE | Direct payment from the plan Service code 50 | — | $8K |
| GALLAGHER BENEFIT SERVICES INC EIN 36-4291971 BROKER | Other commissions Service code 55 | — | $8K |
| NORTHSHORE UNIVERSITY HEALTHSY EIN 36-3738206 NONE | Direct payment from the plan Service code 50 | — | $8K |
| LABORATORY CORPORATION OF AMER EIN 13-3757370 NONE | Direct payment from the plan Service code 50 | — | $7K |
| QUEST DIAGNOSTICS WOOD DA EIN 36-4257926 NONE | Direct payment from the plan Service code 50 | — | $7K |
| PEDIATRIC FACULTY FOUNDATION EIN 36-3279680 NONE | Direct payment from the plan Service code 50 | — | $6K |
| JOHN H STROGER HOSPITAL EIN 36-6006541 NONE | Direct payment from the plan Service code 50 | — | $6K |
| ELDIN KARAIKOVIC EIN 85-2783542 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 | 61 | 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) | 61 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 74 | $4K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 73 | $354K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 74 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 74 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.