| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | PO BOX 2158 RIVERSIDE, CA 92516 | PRINCIPAL LIFE INSURANCE COMPANY | $13K | — | $13K | 5.49% |
| GBS BENEFITS INC3 | DBA GBS BENEFITS INS 465 S 400 E STE 300 SLC, UT 84111 | PRINCIPAL LIFE INSURANCE COMPANY | $6K | — | $6K | 2.70% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL LIMITED | 300 N LA SALLE DR FL 17 CHICAGO, IL 60654 | PRINCIPAL LIFE INSURANCE COMPANY | — | $4K | $4K | 1.84% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | PO BOX 2158 RIVERSIDE, CA 92516 | AMERICAN NATIONAL INSURANCE COMPANY | $11K | — | $11K | 4.52% |
| GBS BENEFITS INS AGENCY3 Filed as: GBS BENEFIT INC | DBA GBS INSURANCE AGENCY 465 SOUTH 400 EAST STE 300 SLC, UT 84111 | AMERICAN NATIONAL INSURANCE COMPANY | $7K | — | $7K | 2.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | PO BOX 2158 RIVERSIDE, CA 92516 | AMERICAN NATIONAL INSURANCE COMPANY | $17K | — | $17K | 7.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $119K |
| GBS BENEFIT INC EIN 87-0680571 BROKER | Other commissions Service code 55 | — | $13K |
| HUB INTERNATIONAL EIN 33-0315047 BROKER | Other commissions Service code 55 | — | $13K |
| NOVO BENEFITS LLC EIN 26-3445510 BROKER | Other commissions Service code 55 | — | $8K |
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 | 432 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 432 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 423 | $239K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 423 | $239K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 423 | $239K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 423 | $239K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 423 | $239K |
| Prescription drug | RXBENEFITS, INC | 139 | $0 |
| Stop-loss / reinsurancereinsurance | AMERICAN NATIONAL INSURANCE COMPANY | 139 | $234K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 423 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.