| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | EMPLOYEE BENEFITS DEPT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $2K | $5K | 28.06% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS-SEATTLE | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 6.59% |
| USI INSURANCE SERVICES LLC3 Filed as: USI NORTHWEST DBA KIBBLE & PRENTICE | HOLDING CO 601 UNION ST STE 1000 SEATTLE, WA 98101 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $374 | $92 | $466 | 2.78% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | EMPLOYEE BENEFITS DEPT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $267 | $267 | 1.59% |
| M FINANCIAL HOLDINGS INC3 | 1125 NW COUCH ST SUITE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $41 | $41 | 0.24% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HUB INTERNATIONAL MIDWEST BROKER | Other commissions Service code 55 | 55 E JACKSON BLVD FLOOR 14 CHICAGO, IL 60604 | $175K |
| PREMERA BLUE CROSS EIN 91-0499247 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $115K |
| NAVIA BENEFIT SOLUTIONS EIN 91-1467758 CLAIMS PROCESSING | Claims processing Service code 12 | — | $15K |
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 | 1,008 | 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) | 1,008 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Short-term disability | UNITEDHEALTCARE INSURANCE COMPANY | 1,008 | $477K |
| Long-term disability | UNITEDHEALTCARE INSURANCE COMPANY | 1,008 | $477K |
| Other(2 contracts, 2 carriers) | UNITEDHEALTCARE INSURANCE COMPANY | 1,008 | $494K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,008 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.