| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TRAVIS PORTA3 | 7219 GRAND RIVER ROAD BRIGHTON, MI 48114 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $87K | $0 | $87K | 2.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST, LTD | 1591 GALBRAITH AVENUE SE GRAND RAPIDS, MI 49546 | BLUE CROSS BLUE SHIELD OF MICHIGAN | $0 | $4K | $4K | 0.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST, LTD | 1591 GALBRAITH AVENUE SE GRAND RAPIDS, MI 49546 | DELTA DENTAL OF MICHIGAN | $13K | $0 | $13K | 6.72% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 203 NORTH LA SALLE STREET FLOOR 20 CHICAGO, IL 60601 | DELTA DENTAL OF MICHIGAN | $3K | $0 | $3K | 1.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BOULEVARD CHICAGO, IL 60604 | DELTA DENTAL OF MICHIGAN | $3K | — | $3K | 1.62% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 2158 RIVERSIDE, CA 92516 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 15.99% |
No Schedule C service providers reported on this filing.
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 | 231 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 231 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF MICHIGAN | 541 | $3.2M |
| Dental | DELTA DENTAL OF MICHIGAN | 595 | $194K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 275 | $32K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 275 | $32K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 275 | $32K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 275 | $32K |
| Prescription drug | BLUE CROSS BLUE SHIELD OF MICHIGAN | 541 | $3.2M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 275 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 595 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.