| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 EAST JACKSON BLVD FL 14 CHICAGO, IL 60604 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $47 | $5K | 11.49% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN & ASSOICATES LLC | 1933 STATE ROUTE 35, STE 368 WALL, NJ 07719 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $458 | $2K | 6.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 16253 COLLECTION CENTER DR FL 4 CHICAGO, IL 60693 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $694 | $694 | 1.77% |
| MICHAEL AHLERT3 | 4049 GRAND AVENUE WESTERN SPRINGS, IL 60558 | TRUSTMARK LIFE INSURANCE | $432 | — | $432 | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | P.O. BOX 2158 RIVERSIDE, CA 92516 | VISION SERVICE PLAN | $392 | — | $392 | 6.69% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1411 OPUS PLACE, STE 450 DOWNERS GROVE, IL 60515 | VISION SERVICE PLAN | $117 | — | $117 | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HUB INTERNATIONAL EIN 35-0672425 NONE | Consulting (general); Insurance agents and brokers Service code 16 | — | $29K |
| TIC INTERNATIONAL, INC. EIN 13-2600875 NONE | Plan Administrator Service code 14 | — | $26K |
| ANTHEM BLUE CROSS & BLUE SHIELD EIN 35-0781558 NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | — | $24K |
| CHEIRON EIN 13-4215617 NONE | Actuarial Service code 11 | — | $17K |
| ALLIED BENEFIT SYSTEMS, INC. EIN 36-3086057 NONE | Claims processing Service code 12 | — | $14K |
| CHERRY BEKAERT LLP EIN 56-0574444 NONE | Accounting (including auditing) Service code 10 | — | $12K |
| MAY, OBERFELL, LORBER LAW FIRM EIN 35-0914880 NONE | Legal Service code 29 | — | $4K |
| 1ST SOURCE NONE | Plan Administrator; Claims processing; Other services Service code 12 | P.O. BOX 1602 SOUTH BEND, IN 46634 | $517 |
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 | 38 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 44 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 149 | $39K |
| Vision | VISION SERVICE PLAN | 25 | $6K |
| Life insurance | TRUSTMARK LIFE INSURANCE | 60 | $9K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 149 | $39K |
| Other | TRUSTMARK LIFE INSURANCE | 60 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 149 | — |
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.