| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VISTA NATIONAL INSURANCE GROUP INC3 Filed as: VISTA NATIONAL INSURANCE GROUP INC. | 1301 W 22ND STREET #600 OAK BROOK, IL 60523 | BLUECROSS BLUESHIELD OF ILLINOIS | $89K | $4K | $93K | 2.74% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | BLUECROSS BLUESHIELD OF ILLINOIS | $28K | — | $28K | 0.84% |
| VISTA NATIONAL INSURANCE GROUP INC3 Filed as: VISTA NATIONAL INS GROUP INC | 1301 W 22ND ST STE 600 OAK BROOK, IL 605232010 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $2K | $8K | 4.58% |
| VISTA NATIONAL INSURANCE GROUP INC3 Filed as: VISTA NATIONAL INSURANCE GROUP | 1301 W 22ND ST STE 600 OAK BROOK, IL 60523 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | $2K | $13K | 13.34% |
| 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 | $848 | $4K | 4.10% |
| VISTA NATIONAL INSURANCE GROUP INC3 Filed as: VISTA NATIONAL INSURANCE GROUP | 1301 W 22ND ST STE 600 OAK BROOK, IL 60523 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $937 | $8K | 15.68% |
| 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 | $781 | $208 | $989 | 1.90% |
| VISTA NATIONAL INSURANCE GROUP INC3 Filed as: VISTA NATIONAL INSURANCE GROUP | 1301 W 22ND ST STE 600 OAK BROOK, IL 60523 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $807 | $7K | 14.41% |
| 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 | $1K | $346 | $2K | 3.35% |
| VISTA NATIONAL INSURANCE GROUP INC3 Filed as: VISTA NATIONAL | 1301 W 22ND ST SUITE 600 OAK BROOK, IL 60523 | HEALTHIEST YOU | $3K | — | $3K | 11.64% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | P.O. BOX 2158 RIVERSIDE, CA 92516 | HEALTHIEST YOU | $987 | — | $987 | 3.37% |
| VISTA NATIONAL INSURANCE GROUP INC3 Filed as: VISTA NATIONAL INSURANCE GROUP | 1301 W 22ND ST STE 600 OAK BROOK, IL 605232010 | VISION SERVICE PLAN | $1K | — | $1K | 4.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 15162 COLLECIION CENTER DR CHICAGO, IL 606930001 | VISION SERVICE PLAN | $211 | — | $211 | 0.74% |
| VISTA NATIONAL INSURANCE GROUP INC3 | 1301 W 22ND ST SUITE 600 OAK BROOK, IL 605232010 | METROPOLITAN LIFE INSURANCE COMPANY | $434 | — | $434 | 10.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $10K |
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 | 582 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 582 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF ILLINOIS | 507 | $3.4M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 695 | $174K |
| Vision | VISION SERVICE PLAN | 351 | $29K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 555 | $98K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 555 | $98K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 555 | $98K |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 555 | $204K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 695 | — |
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.