| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BLVD. FLOOR 12 CHICAGO, IL 60604 | AMERITAS | $13K | — | $13K | 8.03% |
| FRINGE INSURANCE BENEFITS, INC.3 | 11910 ANDERSON MILL ROAD AUSTIN, TX 78726 | AMERITAS | $9K | — | $9K | 5.50% |
| ASSURANCE AGENCY LTD3 | 1750 E. GOLF ROAD 11TH FLOOR SCHAUMBURG, IL 60173 | AMERITAS | $3K | — | $3K | 1.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BLVD. FLOOR 12 CHICAGO, IL 60604 | NATIONWIDE LIFE INSURANCE COMPANY | $10K | — | $10K | 7.75% |
| FRINGE INSURANCE BENEFITS, INC.3 | 11910 ANDERSON MILL ROAD AUSTIN, TX 78726 | NATIONWIDE LIFE INSURANCE COMPANY | $5K | — | $5K | 3.93% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY LTD. | 1750 E. GOLF ROAD 11TH FLOOR SCHAUMBURG, IL 60173 | NATIONWIDE LIFE INSURANCE COMPANY | $3K | — | $3K | 2.25% |
| FRINGE INSURANCE BENEFITS, INC.5 | 11910 ANDERSON MILL ROAD AUSTIN, TX 78726 | NATIONWIDE LIFE INSURANCE COMPANY | — | $9K | $9K | 301.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BLVD. FLOOR 12 CHICAGO, IL 60604 | NATIONWIDE LIFE INSURANCE COMPANY | — | $5K | $5K | 179.74% |
| ASSURANCE AGENCY LTD3 | 1750 E. GOLF ROAD 11TH FLOOR SCHAUMBURG, IL 60173 | NATIONWIDE LIFE INSURANCE COMPANY | — | $2K | $2K | 71.70% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITOL ADMINISTRATORS EIN 68-0116790 INSURANCE TPA | Contract Administrator; Insurance services Service code 13 | 2920 PROSPECT PARK DR., #210 RANCHO CORDOVA, CA 95670 | $74K |
| HUB INTERNATIONAL EIN 35-0672425 INSURANCE BROKER | Insurance agents and brokers Service code 22 | — | $66K |
| CONNECTICUT GENERAL LIFE (CIGNA) EIN 59-1031071 NETWORK ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | P.O. BOX 645014 CINCINNATI, OH 45264 | $38K |
| ALL RISKS EIN 52-0801316 N/A | Other insurance fees and expenses Service code 73 | — | $13K |
| PACIFIC GENERAL UNDERWRITERS EIN 86-0858297 N/A | Other fees Service code 99 | — | $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 | 527 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 540 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS | 747 | $166K |
| Vision | AMERITAS | 747 | $166K |
| Life insurance | NATIONWIDE LIFE INSURANCE COMPANY | 120 | $130K |
| Short-term disability | NATIONWIDE LIFE INSURANCE COMPANY | 120 | $130K |
| Stop-loss / reinsurancereinsurance | NATIONWIDE LIFE INSURANCE COMPANY | 76 | $3K |
| Other | NATIONWIDE LIFE INSURANCE COMPANY | 120 | $130K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 747 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.