| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | EMPLOYEE BENEFITS DEPARTMENT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | AETNA HEALTH, INC. | $70K | — | $70K | 3.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 606044466 | KAISER FOUNDATION HEALTH PLAN INC | $15K | — | $15K | 4.77% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP, INC. | 580 N BANK LN STE 101 LAKE FOREST, IL 600455303 | METROPOLITAN LIFE INSURANCE COMPANY | $7K | — | $7K | 5.84% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 10.77% |
| 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 | — | $323 | $323 | 0.81% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | EMPLOYEE BENEFITS DEPARTMENT 55 JACKSON BLVD #14A CHICAGO, IL 60604 | AETNA LIFE INSURANCE CO. | $39 | — | $39 | 2.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LTD EIN 35-0672425 BROKER | Other commissions Service code 55 | — | $0 |
| JOHN FICKEWIRTH EIN 57-0762120 BROKER | Other commissions Service code 55 | — | $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 | 581 | 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) | 581 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 62 | $325K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 301 | $125K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 301 | $125K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 581 | $40K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 581 | $40K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 581 | $40K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 581 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 581 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.