| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FST ASSOCIATES INC3 Filed as: FST ASSOCIATES | 55 WEST MONROE STE 500 CHICAGO, IL 60603 | DELTA DENTAL OF INDIANA | $5K | — | $5K | 1.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 939 BURLINGTON, NC 27216 | DELTA DENTAL OF INDIANA | $3K | — | $3K | 0.84% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD. | 16162 COLLECTIONS CENTER DRIVE CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $741K | $16K | $757K | 462.53% |
| FST ASSOCIATES INC3 Filed as: FST ASSOCIATES, INC. | 55 WEST MONROE CHICAGO, IL 60603 | DELTA DENTAL OF INDIANA | $2K | — | $2K | 1.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 939 BURLINGTON, NC 27216 | DELTA DENTAL OF INDIANA | $1K | — | $1K | 0.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD. | 15162 COLLECTIONS CENTER DRIVE CHICAGO, IL 60603 | PRUDENTIAL LIFE INSURANCE COMPANY | $75K | $16K | $91K | 68.88% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC EIN 35-0781558 ADMINISTRATION | Float revenue; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator Service code 12 | — | $663K |
| THE PRUDENTIAL INSURANCE COMPANY EIN 22-1211670 ADMINISTRATION | Contract Administrator Service code 13 | — | $50K |
| TOTAL ADMINISTRATIVE SERVICES CORP EIN 39-1561025 ADMINISTRATION | Contract Administrator Service code 13 | — | $20K |
| EXPRESS SCRIPTS, INC EIN 31-1714795 ADMINISTRATIVE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | — | $0 |
| FST ASSOCIATES LAURUS STRATEGIES EIN 35-0781558 BROKER | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $0 |
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 | 1,270 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,281 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM INSURANCE COMPANIES, INC. | 2,233 | $1.2M |
| Dental(2 contracts) | DELTA DENTAL OF INDIANA | 1,423 | $563K |
| Vision | VISION SERVICE PLAN | 881 | $165K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,447 | $164K |
| Long-term disability | PRUDENTIAL LIFE INSURANCE COMPANY | 743 | $132K |
| Prescription drug | ANTHEM INSURANCE COMPANIES, INC. | 2,233 | $1.2M |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. | 2,233 | $1.2M |
| Other(2 contracts, 2 carriers) | COMPSYCH | 1,281 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,233 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.