| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | BLUECROSS BLUESHIELD OF ILLINOIS | $59K | $4K | $63K | 4.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 EAST JACKSON BLVD FLOOR 14B CHICAGO, IL 60604 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $15K | $5K | $20K | 7.99% |
| BLOOM HEALTH INSURANCE AGENCY LLC3 Filed as: BLOOM HEALTH INSURANCE AGENCY | 15 SOUTH 5TH STREET SUITE 300 MINNEAPOLIS, MN 55402 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 4.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BOULEVARD CHICAGO, IL 60604 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 0.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 50 EAST JACKSON BOULEVARD FL 14B CHICAGO, IL 60604 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | $697 | $4K | 17.55% |
| MARK PIETSCH3 Filed as: MARK G PIETSCH | 1751 LAKE COOK ROAD DEERFIELD, IL 60015 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $21 | — | $21 | 0.09% |
| BLOOM HEALTH INSURANCE AGENCY LLC3 | 15 S 5TH STREET STE. 300 MINNEAPOLIS, MN 554021577 | VISION SERVICE PLAN | $2K | — | $2K | 7.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 15162 COLLECTION CENTER DRIVE CHICAGO, IL 606930001 | VISION SERVICE PLAN | $1K | — | $1K | 5.31% |
| EMPYREAN INSURANCE SERVICES, INC.3 Filed as: EMPYREAN INSURANCE SERVICES | 9009 WEST LOOP S STE 600 HOUSTON, TX 770961719 | VISION SERVICE PLAN | $144 | — | $144 | 0.66% |
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 | 197 | 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) | 197 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 378 | $1.6M |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 197 | $253K |
| Vision | VISION SERVICE PLAN | 173 | $22K |
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 197 | $253K |
| Short-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 197 | $253K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 197 | $253K |
| Other(2 contracts) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 197 | $277K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 378 | — |
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.