| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP, INC. | 5110 N. 40TH STREET PHOENIX, AZ 85018 | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | $7K | — | $7K | 1.70% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 6100 S. YALE AVENUE, SUITE 1900 TULSA, OK 74136 | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | — | $4K | $4K | 0.90% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL PBA | 6100 S. YALE AVENUE, SUITE 1900 TULSA, OK 74136 | DELTA DENTAL | $9K | — | $9K | 12.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-AMERICA | 6100 S. YALE AVENUE, SUITE 1900 TULSA, OK 74136 | EYEMED VISION CARE | $680 | — | $680 | 9.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 6100 S. YALE AVENUE, SUITE 1900 TULSA, OK 74136 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $219 | $71 | $290 | 19.88% |
No Schedule C service providers reported on this filing.
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 | 110 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | 145 | $427K |
| Dental | DELTA DENTAL | 168 | $79K |
| Vision | EYEMED VISION CARE | 130 | $7K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 110 | $1K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 110 | $1K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 168 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.