| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST INS | 55 EAST JACKSON BLVD FLOOR 12 CHICAGO, IL 60604 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | — | — | $0 | 0.00% |
| JOSEPH K HALEY3 | 101 N. WACKER DRIVE SUITE 612 CHICAGO, IL 60606 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | — | — | $0 | 0.00% |
| JOSEPH K HALEY3 | 101 N. WACKER DRIVE SUITE 612 CHICAGO, IL 60606 | SUN LIFE ASSURANCE COMPANY OF CANADA | $61K | — | $61K | 15.56% |
| JOSEPH K HALEY3 | 101 N. WACKER DRIVE SUITE 612 CHICAGO, IL 60606 | METROPOLITAN LIFE INSURANCE COMPANY | $25K | — | $25K | 8.00% |
| CENTRO BENEFITS RESEARCH LLC3 | 325 N KIRKWOOD ROAD SUITE 300 KIRKWOOD, MO 63122 | METROPOLITAN LIFE INSURANCE COMPANY | $12K | $3K | $15K | 4.86% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 16253 COLLECTION CENTER DR 40 W MADISON 4TH FLOOR CHICAGO, IL 60693 | METROPOLITAN LIFE INSURANCE COMPANY | — | $782 | $782 | 0.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 EAST JACKSON BLVD CHICAGO, IL 60604 | METROPOLITAN LIFE INSURANCE COMPANY | $10 | — | $10 | 0.00% |
| JOSEPH K HALEY3 | 812 N WASHINGTON AVE PARK RIDGE, IL 60068 | VISION SERVICE PLAN | $2K | — | $2K | 3.43% |
| JOSEPH K HALEY3 Filed as: JOSEPH HALEY | 101 N. WACKER DRIVE SUITE 612 CHICAGO, IL 60606 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $419 | — | $419 | 7.72% |
| CENTRO BENEFITS RESEARCH LLC3 | 325 N KIRKWOOD RD SUITE 300 KIRKWOOD, MO 63122 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $210 | $44 | $254 | 4.68% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 3390 UNIVERSITY AVE, SUITE 300 RIVERSIDE, CA 92501 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | — | $11 | $11 | 0.20% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CALIFORNIA PHYSICIANS SERVICE EIN 94-0360524 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 50 BEALE ST SAN FRANCISO, CA 94105 | $294K |
| JOSEPH K HALEY BROKER | Other commissions; Insurance agents and brokers Service code 22 | 101 N. WAKER DRIVE CHICAGOL, IL 60606 | $176K |
| RX BENEFITS INC. EIN 63-1157085 CLAIMS PROCESSING | Claims processing Service code 12 | — | $4K |
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 | 584 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 142 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 726 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 713 | $313K |
| Vision | VISION SERVICE PLAN | 359 | $57K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 486 | $392K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 486 | $392K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 486 | $392K |
| Stop-loss / reinsurancereinsurance | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | 413 | $1.0M |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 486 | $392K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 713 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.