| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | GUARDIAN | $54K | $0 | $54K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 14 CHICAGO, IL 60604 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $12K | $0 | $12K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 14 CHICAGO, IL 60604 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $12K | $0 | $12K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 14 CHICAGO, IL 60604 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $9K | $0 | $9K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 14 CHICAGO, IL 60604 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 14 CHICAGO, IL 60604 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $62 | $0 | $62 | 15.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1411 OPUS PLACE STE 450 DOWNERS GROVE, IL 60515 | VSP VISION CARE FOR LIFE | $108 | $0 | $108 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF ILLINOIS EIN 36-1236610 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $4.7M |
| HEALTHCHECK360 NONE | Other services; Direct payment from the plan Service code 49 | 800 MAIN ST. DUBUQUE, IA 52001 | $662K |
| DAVIS VISION INC. EIN 11-3051991 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $83K |
| GROUP ADMINISTRATORS, LTD. EIN 36-3381052 NONE | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $80K |
| COMPSYCH CORPORATION EIN 36-3739783 NONE | Direct payment from the plan; Other services Service code 49 | — | $9K |
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 | 444 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 451 | 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 | 172 | $1.1M |
| Dental | GUARDIAN | 437 | $540K |
| Vision | VSP VISION CARE FOR LIFE | 0 | $0 |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 440 | $191K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 406 | $80K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 359 | $82K |
| Other(4 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 80 | $77K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 440 | — |
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.