| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MUTUAL MEDICAL3 Filed as: MUTUAL MEDICAL C/O RON JONES | 416 MAIN ST, STE 1025 PEORIA, IL 61602 | SYMETRA LIFE INSURANCE COMPANY | — | $12K | $12K | 4.09% |
| MUTUAL MEDICAL3 Filed as: MUTUAL MEDICAL C/O RON JONES | 416 MAIN ST, STE 1025 PEORIA, IL 61602 | SYMETRA LIFE INSURANCE COMPANY | — | $558 | $558 | 4.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXPRESS SCRIPTS, INC EIN 22-3461740 NONE | Contract Administrator; Claims processing Service code 12 | — | $415K |
| MUTUAL MEDICAL OF ROCKFORD EIN 30-0084263 NONE | Contract Administrator; Plan Administrator; Claims processing Service code 12 | — | $85K |
| EMPLOYERS COALITION ON HEALTH EIN 36-3943539 NONE | Contract Administrator Service code 13 | — | $25K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Accounting (including auditing) Service code 10 | — | $23K |
| DMI GROUP, INC. EIN 20-2917318 NONE | Consulting (general) Service code 16 | — | $20K |
| SHEET METAL WORKERS LOCAL 219 EIN 36-1764275 AFFILIATED UNION | Plan Administrator Service code 14 | — | $8K |
| MEKETA INVESTMENT GROUP, INC. EIN 04-2659023 NONE | Investment advisory (plan) Service code 27 | — | $8K |
| HFN, LLC EIN 36-3353243 NONE | Contract Administrator Service code 13 | — | $7K |
| O'SULLIVAN AND ASSOCIATES, INC. EIN 20-8199367 NONE | Actuarial Service code 11 | — | $6K |
| MIDLAND STATES BANK EIN 37-0259550 NONE | Custodial (other than securities) Service code 18 | — | $4K |
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 | 293 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 37 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 330 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 323 | $14K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 332 | $287K |
| Other | SYMETRA LIFE INSURANCE COMPANY | 323 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 332 | — |
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.