| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 | 1750 EAST GOLF ROAD SCHAUMBURG, IL 60173 | METROPOLITAN LIFE INSURANCE COMPANY | $29K | $807 | $29K | 6.42% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E. JACKSON BLVD, 14TH FLOOR CHICAGO, IL 60604 | METROPOLITAN LIFE INSURANCE COMPANY | $19K | $0 | $19K | 4.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 16253 COLLECTION CENTER DR. CHICAGO, IL 60693 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $4K | $4K | 0.84% |
| ASSURANCE AGENCY LTD3 | 1750 EAST GOLF ROAD SCHAUMBURG, IL 60173 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $11K | — | $11K | 7.81% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E. JACKSON BLVD, 14TH FLOOR CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $10K | — | $10K | 7.19% |
| ASSURANCE AGENCY LTD3 | 1750 EAST GOLF ROAD SCHAUMBURG, IL 60173 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 7.77% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E. JACKSON BLVD, 14TH FLOOR CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 7.23% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF ILLINOIS EIN 36-1236610 NONE | Claims processing Service code 12 | — | $3.8M |
| GROUP ADMINISTRATORS, LTD. EIN 36-3381052 NONE | Contract Administrator Service code 13 | — | $69K |
| COMPSYCH CORPORATION EIN 36-3739783 NONE | Other services Service code 49 | — | $21K |
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 | 445 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 450 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 226 | $1.4M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 1,032 | $457K |
| Vision | VSP VISION CARE FOR LIFE | 450 | $39K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 443 | $99K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $77K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $141K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,032 | — |
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."
No prospect flags tripped on this filing.