Form 5500 · Employee benefit plan · CINCINNATI, OH
FUSSBALL CLUB CINCINNATI, LLC
Public Form 5500 records show how FUSSBALL CLUB CINCINNATI, LLC of CINCINNATI, OH, a arts, entertainment and recreation employer, structures its employee benefits. Its broker of record is SECOND ACT BENEFITS INC. Coverage is written through MEDICAL MUTUAL OF OHIO and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 38-4085137 · plan 501 · plan year 2024, filed Oct 13, 2025
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: death benefits, other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 4 insured contracts covering health, dental, vision, life and disability; the largest, with MEDICAL MUTUAL OF OHIO, covers 145 people.
Reported premium across the insured contracts is $1,894,305, with $76,559 in disclosed broker commissions — about 4% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
SECOND ACT BENEFITS INC is the broker of record on 1 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including MEDICAL MUTUAL OF OHIO, STANDARD INSURANCE COMPANY, SUPERIOR DENTAL CARE and EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO.. MEDICAL MUTUAL OF OHIO writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| MEDICAL MUTUAL OF OHIO | Health | 145 | Jan 1, 2025 | $1,671,987 | $62,003 |
| STANDARD INSURANCE COMPANY | Life, Disability | 201 | Jan 1, 2025 | $126,653 | $9,472 |
| SUPERIOR DENTAL CARE | Dental | 146 | Jan 1, 2025 | $69,275 | $3,451 |
| EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | Vision | 265 | Jan 1, 2025 | $26,390 | $1,633 |
Premium and claims on these contracts
STANDARD INSURANCE COMPANY, contract 163206. For the contract year on this filing, the carrier reported $126,653 in premium earned and $36,167 in claims incurred. Dividing one by the other gives 29%.
SUPERIOR DENTAL CARE, contract 513232. For the contract year on this filing, the carrier reported $69,275 in premium earned and $60,025 in claims incurred. Dividing one by the other gives 87%.
- STANDARD INSURANCE COMPANY, contract 163206 reported $90,489 in retention.
- SUPERIOR DENTAL CARE, contract 513232 reported $14,149 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 150 employees, 0 recordable cases, 0 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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