| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | EMPLOYEE BENEFITS DEPT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $4K | $4K | 1.75% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN & ASSOCIATES | 2338 IMMOKALEE RD STE 240 NAPLES, FL 34110 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | — | $5K | 2.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | EMPLOYEE BENEFITS DEPT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $3K | $3K | 1.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | EMPLOYEE BENEFITS DEPT 55 E JACKSON BLVD #14A CHICAGO, IN 60604 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 1.75% |
| SELECT NETWORKS5 | 317 6TH AVE., SUITE 1040 DES MOINES, IA 50309 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $7K | — | $7K | 8.79% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF IL EIN 36-1236610 ADMINISTRATIVE SERVICES | Claims processing; Contract Administrator Service code 12 | — | $550K |
| RXBENEFITS, INC. EIN 63-1157085 CLAIMS PROCESSING | Claims processing; Contract Administrator Service code 12 | — | $9K |
| HUB INTERNATIONAL MIDWEST LTD BROKER | Insurance agents and brokers Service code 22 | 55 E JACKSON BLVD CHICAGO, IL 60604 | $0 |
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 | 695 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 704 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 1,257 | $78K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 684 | $91K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 597 | $853K |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,188 | $530K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,257 | — |
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."
No prospect flags tripped on this filing.