| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | BLUECROSS BLUESHIELD OF ILLINOIS | $57K | $2K | $59K | 3.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST WEST | 55 E JACKSON BLVD CHICAGO, IL 60604 | DELTA DENTAL OF ILLINOIS | $3K | — | $3K | 5.43% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN & ASSOCIATES | 1800 ROUTE 34 BUILDING 4 SUITE 404A WALL TOWNSHIP, NJ 07719 | DELTA DENTAL OF ILLINOIS | $226 | — | $226 | 0.45% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD STE 14A CHICAGO, IL 60604 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 4.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNAIONAL MIDWEST LIMITED | 55 E JACKSON BLVD STE 14A CHICAGO, IL 60604 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD STE 14A CHICAGO, IL 60604 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD STE 14A CHICAGO, IL 60604 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 3.96% |
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 | 73 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 74 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 292 | $1.9M |
| Dental | DELTA DENTAL OF ILLINOIS | 91 | $51K |
| Vision | DELTA DENTAL OF ILLINOIS | 91 | $51K |
| Life insurance | STANDARD INSURANCE COMPANY | 207 | $38K |
| Long-term disability | STANDARD INSURANCE COMPANY | 207 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 292 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.