| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E JACKSON BLVD FL 14 CHICAGO, IL 606044466 | METROPOLITAN LIFE INSURANCE COMPANY | $56K | $54 | $56K | 9.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 16253 COLLECTION CENTER DR. CHICAGO, IL 606930162 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $7K | $7K | 1.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | P.O. BOX 2167 GRAND RAPIDS, MI 49501 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $12K | $0 | $12K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | P.O. BOX 2167 GRAND RAPIDS, MI 49501 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $11K | $0 | $11K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | P.O. BOX 2167 GRAND RAPIDS, MI 49501 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $7K | $0 | $7K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | P.O. BOX 2167 GRAND RAPIDS, MI 49501 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | P.O. BOX 2167 GRAND RAPIDS, MI 49501 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $79 | $0 | $79 | 14.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF ILLINOIS EIN 36-1236610 NONE | Claims processing Service code 12 | — | $4.1M |
| GROUP ADMINISTRATORS, LTD. EIN 36-3381052 NONE | Contract Administrator Service code 13 | — | $74K |
| COMPSYCH CORPORATION EIN 36-3739783 NONE | Other services Service code 49 | — | $24K |
| BUTLER HEALTHCORP, INC. EIN 42-1403200 NONE | Other services Service code 49 | — | $16K |
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 | 448 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 458 | 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 | 210 | $1.4M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 1,057 | $618K |
| Vision | VSP VISION CARE FOR LIFE | 453 | $41K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 447 | $111K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 395 | $83K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 382 | $74K |
| Other(4 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 65 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,057 | — |
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.