| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BLVD., FLOOR 12 CHICAGO, IL 60604 | NATIONWIDE | $17K | — | $17K | 9.11% |
| FRINGE INSURANCE BENEFITS, INC.3 | 11910 ANDERSON MILL RD AUSTIN, TX 78726 | NATIONWIDE | $13K | — | $13K | 6.84% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BLVD., FLOOR 12 CHICAGO, IL 60604 | AMERITAS | $9K | — | $9K | 10.00% |
| FRINGE INSURANCE BENEFITS, INC.3 | 11910 ANDERSON MILL RD AUSTIN, TX 78726 | AMERITAS | $5K | — | $5K | 5.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BLVD CHICAGO, IL 60604 | BLUECROSS BLUESHIELD OF ARIZONA | $204 | — | $204 | 1.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BLVD., FLOOR 12 CHICAGO, IL 60604 | MADISON NATIONAL LIFE | $283 | — | $283 | 10.01% |
| FRINGE INSURANCE BENEFITS, INC.3 | 11910 ANDERSON MILL RD AUSTIN, TX 78726 | MADISON NATIONAL LIFE | $198 | — | $198 | 7.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FRINGE INSURANCE BENEFITS, INC. EIN 74-2616364 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 11910 ANDERSON MILL RD AUSTIN, TX 78726 | $42K |
| HUB INTERNATIONAL MIDWEST LIMITED EIN 35-0672425 BROKER | Other commissions Service code 55 | 55 EAST JACKSON BLVD., FLOOR 12 CHICAGO, IL 60604 | $21K |
| FIRST HEALTH EIN 20-1736437 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 3200 HIGHLAND AVENUE DOWNERS GROVE, IL 60515 | $6K |
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 | 269 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 269 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | NATIONWIDE | 221 | $194K |
| Dental | AMERITAS | 301 | $91K |
| Vision | AMERITAS | 301 | $91K |
| Life insurance | NATIONWIDE | 221 | $191K |
| Short-term disability | NATIONWIDE | 221 | $191K |
| Stop-loss / reinsurancereinsurance | NATIONWIDE | 221 | $191K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 301 | — |
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.