| 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 60604 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $0 | $3K | 11.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 16253 COLLECTION CENTER DR., FL. 4 CHICAGO, IL 60693 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $673 | $673 | 2.29% |
| MICHAEL AHLERT3 | 4049 GRAND AVE. WESTERN SPRINGS, IL 60558 | TRUSTMARK LIFE INSURANCE | $505 | — | $505 | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 15162 COLLECTION CENTER DRIVE CHICAGO, IL 60693 | VISION SERVICE PLAN | $827 | — | $827 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| STEWART C. MILLER & CO., INC. EIN 35-1820020 NONE | Plan Administrator Service code 14 | 2111 W. LINCOLN HIGHWAY MERRILLVILLE, IN 46140 | $33K |
| ALLIED BENEFIT SYSTEMS, INC. EIN 36-3086057 NONE | Claims processing Service code 12 | 200 W. ADAMS ST., STE. 500 CHICAGO, IL 60606 | $20K |
| HUB INTERNATIONAL EIN 35-0672425 NONE | Consulting (general); Insurance agents and brokers Service code 16 | 55 EAST JACKSON BLVD. CHICAGO, IL 60604 | $20K |
| CORESOURCE EIN 35-1846036 NONE | Other services; Plan Administrator; Claims processing Service code 12 | 18401 MAPLE CREEK DRIVE, SUITE 300 TINLEY PARK, IL 60477 | $14K |
| K.B. PARRISH & CO., LLP EIN 35-0905983 NONE | Accounting (including auditing) Service code 10 | 6840 EAGLE HIGHLANDS WAY INDIANAPOLIS, IN 46254 | $14K |
| CHEIRON EIN 13-4215617 NONE | Actuarial Service code 11 | 230 WEST MONROE STREET, SUITE 2150 CHICAGO, IL 60606 | $13K |
| ANTHEM BLUE CROSS AND BLUE SHIELD NONE | Insurance services Service code 23 | P.O. BOX 951254 CLEVELAND, OH 44193 | $10K |
| URDA PROFESSIONAL CORPORATION EIN 35-1755675 NONE | Legal Service code 29 | 112 W. JEFFERSON BLVD. 503 SOUTH BEND, IN 46601 | $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 | 95 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 16 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE | 121 | $261K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 132 | $29K |
| Vision | VISION SERVICE PLAN | 57 | $8K |
| Life insurance | TRUSTMARK LIFE INSURANCE | 113 | $10K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 132 | $29K |
| Stop-loss / reinsurancereinsurance | HCC LIFE | 121 | $261K |
| Other | TRUSTMARK LIFE INSURANCE | 113 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 132 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.