| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | GUARDIAN | $69K | $0 | $69K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 14 CHICAGO, IL 60604 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $13K | $0 | $13K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 14 CHICAGO, IL 60604 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $13K | $0 | $13K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 14 CHICAGO, IL 60604 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $11K | $0 | $11K | 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 | $69 | $0 | $69 | 15.03% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH SERVICES COALITION EIN 88-0492643 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $7.0M |
| SISCO EIN 42-1144827 NONE | Other services; Direct payment from the plan Service code 49 | — | $774K |
| DAVIS VISION INC. EIN 11-3051991 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $95K |
| GROUP ADMINISTRATORS, LTD. EIN 36-3381052 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $87K |
| COMPSYCH CORPORATION EIN 36-3739783 NONE | Direct payment from the plan; Other services Service code 49 | — | $38K |
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 | 475 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 478 | 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 | 156 | $1.2M |
| Dental | GUARDIAN | 462 | $688K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 466 | $223K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 426 | $87K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 362 | $89K |
| Other(4 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 103 | $88K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 466 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.