| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: BOLTON PARTNERS | 36 S. CHARLES STREET, SUITE 100 BALTIMORE, MD 21201 | ULLICO | $17K | — | $17K | 6.51% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENESYS, INC. EIN 53-0257019 NONE | Direct payment from the plan; Plan Administrator Service code 14 | 7130 COLUMBIA GATEWAY DR, SUITE A COLUMBIA, MD 21046 | $130K |
| O'DONOGHUE & O'DONOGHUE LLP EIN 53-0120528 NONE | Legal; Direct payment from the plan Service code 29 | 5301 WISCONSIN AVENUE NW 800 WASHINGTON, DC 20015 | $74K |
| NAT'L CAPITAL ADMIN SERVICES, INC NONE | Direct payment from the plan; Insurance services Service code 23 | 3928 PENDER DR 100 FAIRFAX, VA 22030 | $34K |
| AMERICAN HEALTH HOLDING NONE | Direct payment from the plan; Claims processing Service code 12 | 7400 WEST CAMPUS ROAD F-510 NEW ALBANY, OH 430548725 | $33K |
| BOLTON PARTNERS NONE | Actuarial; Consulting (general); Direct payment from the plan Service code 11 | 36 S. CHARLES ST. 1000 BALTIMORE, MD 21201 | $30K |
| PNC CAPITAL ADVISORS, LLC EIN 25-1511909 NONE | Custodial (securities); Direct payment from the plan Service code 19 | 1900 EAST 9TH ST B7-YB13-14-1 CLEVELAND, OH 44114 | $28K |
| CALIBRE CPA GROUP, PLLC EIN 20-8078757 NONE | Direct payment from the plan Service code 50 | 4600 EAST WEST HIGHWAY, SUITE 300 BETHESDA, MD 20814 | $21K |
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 | 645 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 645 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ULLICO | 578 | $255K |
| Prescription drug | CVS CAREMARK | 645 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 645 | — |
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.