| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 15162 COLLECTION CENTER DR CHICAGO, IL 60693 | VISION SERVICE PLAN | $2K | — | $2K | 1.77% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC-NEWPORT NEWS | ATTN MID ATLANTIC REGION PO BOX 61007 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $393 | $10K | 8.08% |
| SMITH, THOMAS, CHRISTOPHER3 | PO BOX 6650 METAIRIE, LA 70009 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $160 | $5K | 3.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 606044466 | UNITEDHEALTHCARE INSURANCE COMPANY | $4K | — | $4K | 6.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 500 COUNTRY PINE LANE BATTLE CREEK, MI 49015 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $14K | — | $14K | 35.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 3635 RIVERSIDE PLAZA DR RIVERSIDE, CA 92506 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 14.77% |
| USI INSURANCE SERVICES LLC3 | ATTN ACCOUNTING CENTER PO BOX 3716 NORFOLK, VA 235143716 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 4.21% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $358 | $358 | 0.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $683 | — | $683 | 10.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VIRGINIA EIN 54-0357120 NETWORK PHARMACY | Claims processing; Other services; Other fees; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $669K |
| DELTA DENTAL OF VIRGINIA EIN 54-0844477 DENTAL CLAIMS ADMIN | Contract Administrator Service code 13 | — | $82K |
| THE PRUDENTIAL INSURANCE CO EIN 22-1211670 ADMINISTRATION SERVICES | Contract Administrator Service code 13 | — | $47K |
| COMPSYCH EIN 35-3739783 THIRD PARTY FEES | Contract Administrator Service code 13 | — | $26K |
| EXPRESS SCRIPTS, INC EIN 31-1714795 CONTRACT ADMINISTRATOR | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | — | $0 |
| HUB INTERNATIONAL MIDWEST LIMITED EIN 35-0672425 BROKER | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | — | $0 |
| USI INS SERVICES LLC EIN 13-3771734 BROKER | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | — | $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 | 989 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 25 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,014 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 9 | $109K |
| Vision | VISION SERVICE PLAN | 965 | $137K |
| Life insurance(4 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 990 | $640K |
| Short-term disability(2 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 989 | $130K |
| Long-term disability(3 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 990 | $334K |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF VIRGINA, INC | 2,068 | $698K |
| Other(5 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 989 | $316K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,068 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.