| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2 PIERCE PLACE ITASCA, IL 60143 | BLUE CROSS/BLUE SHIELD OF ILLINOIS | $102K | $80K | $182K | 10.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 2167 GRAND RAPIDS, MI 49501 | SUN LIFE ASSURANCE COMPANY OF CANADA | $53K | — | $53K | 15.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 2158 RIVERSIDE, CA 92516 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $19K | $19K | 5.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 2850 GOLF RD 5TH FL ROLLING MEADOWS, IL 60008 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS/BLUE SHIELD EIN 36-1236610 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $1.7M |
| CLIFTONLARSONALLEN LLP EIN 41-0746749 PLAN AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $23K |
| SUN LIFE ASSURANCE CO OF CANANDA EIN 38-1082080 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $16K |
| HUB INTERNATIONAL MIDWEST LIMITED BROKER | Insurance agents and brokers; Other commissions Service code 22 | 2800 S RIVER RD STE 130 DES PLAINES, IL 60018 | $2K |
| HUB INTERNATIONAL MIDWEST LILMITED BROKER | Insurance agents and brokers; Other commissions Service code 22 | PO BOX 2158 RIVERSIDE, CA 92516 | $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 | 1,238 | 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) | 1,238 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,238 | $351K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS/BLUE SHIELD OF ILLINOIS | 1,918 | $1.7M |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,238 | $351K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,918 | — |
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.