| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SBR SERVICES LLC3 Filed as: SBR SERVICES, LLC | 2839 PACES FERRY RD STE 830 ATLANTA, GA 30339 | RELIASTAR LIFE INSURANCE COMPANY | -$18K | $76K | $58K | 5.32% |
| 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 | — | $9K | $9K | 2.92% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN & ASSOCIATES | 1933 STATE ROUTE 35 SUITE 368 WALL, NJ 07719 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $11K | $11K | 4.66% |
| 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 | — | $6K | $6K | 2.52% |
| 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 | 3.18% |
| SCALETTA INSURANCE AGENCY INC3 | 15 N WINDSOR DR ARLINGTON HEIGHTS, IL 60004 | CONTINENTAL AMERICAN INSURANCE COMPANY | $835 | — | $835 | 2.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 14 CHICAGO, IL 60604 | CONTINENTAL AMERICAN INSURANCE COMPANY | $816 | — | $816 | 2.25% |
| ROCKWELL & ASSOCIATES3 Filed as: ROCKWELL & ASSOCIATES LTD | 303 W ERIE STE 400 CHICAGO, IL 60654 | CONTINENTAL AMERICAN INSURANCE COMPANY | $668 | — | $668 | 1.84% |
| ROBERT J AURIN3 | 2737 N HAMPDEN CT CHICAGO, IL 60614 | CONTINENTAL AMERICAN INSURANCE COMPANY | $331 | — | $331 | 0.91% |
| CAROLINE R OCONNOR3 | 2611 WEST AGATITE AVENUE CHICAGO, IL 606253010 | CONTINENTAL AMERICAN INSURANCE COMPANY | $140 | — | $140 | 0.39% |
| SARAH M CHIESA3 | 3900 N DAMEN APT 301 CHICAGO, IL 60618 | CONTINENTAL AMERICAN INSURANCE COMPANY | $123 | — | $123 | 0.34% |
| VINCENT SCALETTA3 Filed as: VINCENT J SCALETTA | 15 N WINDSOR DR ARLINGTON HEIGHTS, IL 600046564 | CONTINENTAL AMERICAN INSURANCE COMPANY | $83 | — | $83 | 0.23% |
| SCALETTA INSURANCE AGENCY INC3 | 15 N WINDSOR DR ARLINGTON HEIGHTS, IL 60004 | CONTINENTAL AMERICAN INSURANCE COMPANY | $78 | — | $78 | 0.22% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | EMPLOYEE BENEFITS DEPT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $50 | $2K | 5.44% |
| SMITH, THOMAS, CHRISTOPHER3 | PO BOX 40386 798 BERRY RD NASHVILLE, TN 37204 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $274 | — | $274 | 0.77% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | EMPLOYEE BENEFITS DEPT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $642 | $19 | $661 | 9.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | EMPLOYEE BENEFITS DEPT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $753 | -$123 | $630 | 8.75% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN & ASSOCIATES | 1933 STATE ROUTE 35 SUITE 368 WALL, NJ 07719 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $266 | $266 | 5.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | EMPLOYEE BENEFITS DEPT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $241 | $241 | 5.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF IL EIN 36-1236610 ADMINISTRATIVE SERVICES | Contract Administrator; Claims processing Service code 12 | — | $532K |
| UNUM LIFE INSURANCE CO OF AMERICA EIN 01-0278678 N/A | Contract Administrator Service code 13 | — | $20K |
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 NONE | Contract Administrator; Claims processing Service code 12 | — | $15K |
| RXBENEFITS, INC. EIN 63-1157085 CLAIMS PROCESSING | Contract Administrator; Claims processing Service code 12 | — | $10K |
| 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 | 744 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 24 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 768 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 628 | $109K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 745 | $113K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 13 | $5K |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 621 | $1.1M |
| Other(7 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,228 | $756K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,228 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.