| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FST ASSOCIATION INC3 | 55 E JACKSON BLVD STE 1400 CHICAGO, IL 606044466 | METROPOLITAN LIFE INSURANCE COMPANY | $22K | $5K | $27K | 9.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 606044466 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | $0 | $8K | 2.88% |
| FST ASSOCIATION INC3 | 55 W MONROE ST STE 500 CHICAGO, IL 606035151 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $0 | $3K | 1.24% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $16K | $5K | $21K | 13.62% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CTR DR CHICAGO, IL 60693 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 2.46% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ILLINOIS INC C/O INNOTECH | 233 S WACKER DR STE 2000 CHICAGO, IL 60603 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $385 | — | $385 | 0.25% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MINNESOTA INC | PO BOX 93076 CHICAGO, IL 60673 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $269 | — | $269 | 0.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $240 | $240 | 0.16% |
| EBC, INC.3 Filed as: EBC INC | PO BOX 20443 INDIANAPOLIS, IN 46220 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 0.02% |
| MARY S PYLE3 | PO BOX 2608 GULFPORT, MS 39505 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.02% |
| MATTHEW J ORDILLE3 | 31 PEAR TREE PL SEWELL, NJ 08080 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.01% |
| ROBERT P PEDEN3 | 18 53RD STREET GULFPORT, MS 39507 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.01% |
| FST ASSOCIATES INC3 Filed as: FST ASSOCIATES, INC | 2200 GENOA BUSINESS PARK DR BRIGHTON, MI 481147370 | VISION SERVICE PLAN | $1K | $0 | $1K | 1.20% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH ST HAMMONTON, NJ 08037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $836 | $11K | 14.86% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CTR DR CHICAGO, IL 60693 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $12 | $3K | 3.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $580K |
| FST ASSOCIATES INC EIN 36-3832755 BROKER | Other commissions Service code 55 | — | $0 |
| HUB INTERNATIONAL MIDWEST LIMITED EIN 35-0672425 BROKER | Other commissions Service code 55 | — | $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 | 748 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 751 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 788 | $92K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,223 | $421K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 628 | $153K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 1,223 | $269K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,223 | $340K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,223 | — |
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.