| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 2167 GRAND RAPIDS, MI 49501 | SUN LIFE ASSURANCE COMPANY OF CANADA | $109K | $83K | $192K | 17.00% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 | 1933 STATE ROUTE 35 STE 368 WALL, NJ 07719 | SUN LIFE ASSURANCE COMPANY OF CANADA | $27K | — | $27K | 2.36% |
| EMPYREAN INSURANCE SERVICES, INC.3 Filed as: EMPYREAN INSURANCE SERVICES INC | 15 SOUTH 5TH STREET SUITE 300 MINNEAPOLIS, MN 55402 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $15K | — | $15K | 1.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 14 CHICAGO, IL 606044466 | VISION SERVICE PLAN | $29K | — | $29K | 9.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 2158 RIVERSIDE, CA 92516 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $6K | $6K | 4.72% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 | 1933 STATE ROUTE 35 STE 368 WALL, NJ 07719 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 2.71% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 2158 RIVERSIDE, CA 92516 | SUN LIFE AND HEALTH INSURANCE COMPANY | — | $862 | $862 | 6.20% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 | 1933 STATE RTE 35 STE 368 WALL, NJ 07719 | SUN LIFE AND HEALTH INSURANCE COMPANY | $384 | — | $384 | 2.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | LERONE SIDBERRY 55 EAST JACKSON BLVD, FIR 14 CHICAGO, IL 60604 | UNITEDHEALTHCARE INSURANCE COMPANY | $969 | — | $969 | 10.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 2158 RIVERSIDE, CA 92516 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $55 | $55 | 15.58% |
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 | 2,778 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 25 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,803 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | TRIPLE S SALUD, INC. | 4 | $37K |
| Dental(2 contracts, 2 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,708 | $1.0M |
| Vision | VISION SERVICE PLAN | 1,491 | $293K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 3,015 | $1.1M |
| Short-term disability(4 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 3,015 | $1.3M |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 3,015 | $1.1M |
| Prescription drug | TRIPLE S SALUD, INC. | 4 | $26K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 3,015 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,015 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.