| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AXION RMS LTD3 | 2443 WARRENVILLE RD SUITE 610 LISLE, IL 60532 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $28K | $999 | $29K | 15.84% |
| AXION RMS LTD3 Filed as: AXION RMS LTD. | 2443 WARRENVILLE RD SUITE 610 LISLE, IL 60532 | EYEMED VISION CARE | $3K | — | $3K | 11.17% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PHARMACY BENEFIT MANAGM. | Claims processing; Direct payment from the plan; Other fees; Float revenue Service code 12 | — | $543K |
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $198K |
| AXION RMS LTD EIN 47-2464302 BROKER | Other commissions; Insurance agents and brokers Service code 22 | 2443 WARRENVILLE RD SUITE 610 LISLE, IL 60532 | $77K |
| DELTA DENTAL OF MICHIGAN EIN 38-1791480 BENEFIT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $13K |
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 | 336 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 336 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE | 352 | $23K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 336 | $182K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 336 | $182K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 336 | $182K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 340 | $467K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 336 | $182K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 352 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.