| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL SERVICES | 180 RIVER ROAD, SUITE 200 SUMMIT, NJ 07901 | DELAWARE AMERICAN LIFE INSURANCE COMPANY | $11K | — | $11K | 5.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SUNTRUST TRUST MANAGEMENT | Trustee (bank, trust company, or similar financial institution) Service code 21 | GA-ATL-210 PO BOX 4655 ATLANTA, GA 30302 | $36K |
| MICHAEL MARCHETTI CONSULTING | Consulting fees Service code 70 | 20412 REYCROFT COURT MONTGOMERY VILLAGE, MD 20886 | $28K |
| NIXON PEABODY EIN 16-0764720 LEGAL | Legal Service code 29 | — | $25K |
| DONNA BLACK CONSULTING | Consulting fees Service code 70 | 126 WESSEX PLACE FORT THOMAS, KY 41075 | $15K |
| GOVATOS INVESTMENT CONSULTING EIN 23-2986828 INVESTMENT CONSULTING | Investment management Service code 28 | — | $13K |
| USI CONSULTING ACTUARIAL | Actuarial Service code 11 | 95 GLASTONBURY BOULEVARD GLASTONBURY, CT 06033 | $11K |
| BENEFIT ANALYSIS INC. RETIREE PLAN ADMIN | Plan Administrator Service code 14 | PO BOX 527 NUTLEY, NJ 07110 | $9K |
| JAY SHAPIRO & ASSOCIATES CONSULTANT | Consulting fees Service code 70 | 73 CROOKED STICK ROAD JACKSON, NJ 08527 | $7K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 242 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 242 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | DELAWARE AMERICAN LIFE INSURANCE COMPANY | 857 | $201K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 242 | $0 |
| Other | DELAWARE AMERICAN LIFE INSURANCE COMPANY | 857 | $201K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 857 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.