| 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 606044466 | KAISER FOUNDATION HEALTH PLAN INC. | $73K | — | $73K | 1.12% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP, INC. | 580 N BANK LANE STE 101 LAKE FOREST, IL 600455303 | METROPOLITAN LIFE INSURANCE COMPANY | $63K | — | $63K | 3.69% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD, 14TH FLOOR A CHICAGO, IL 60604 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $34K | $13K | $47K | 5.53% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $6K | $4K | $10K | 1.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | EYEMED VISION CARE | $29K | — | $29K | 8.74% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | EYEMED VISION CARE | $2K | — | $2K | 0.72% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | EYEMED VISION CARE | $21K | — | $21K | 7.31% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | EYEMED VISION CARE | $6K | — | $6K | 2.05% |
| FOREST FINANCIAL GROUP INC3 | 580 N BANK LN STE 101 LAKE FOREST, IL 600455303 | METROPOLITAN LIFE INSURANCE COMPANY | $10K | — | $10K | 3.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 15162 COLLECTION CENTER DRIVE CHICAGO, IL 60693 | HYATT LEGAL PLANS | $5K | — | $5K | 8.37% |
| FOREST FINANCIAL GROUP INC3 Filed as: FOREST FINANCIAL GROUP, INC. | 580 N BANK LANE STE 101 LAKE FOREST, IL 60045 | HYATT LEGAL PLANS | $512 | — | $512 | 0.79% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD, 14TH FLOOR CHICAGO, IL 60604 | GERBER LIFE INSURANCE COMPANY | $4K | — | $4K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | EYEMED VISION CARE | $911 | — | $911 | 8.47% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | EYEMED VISION CARE | $88 | — | $88 | 0.82% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | EYEMED VISION CARE | $838 | — | $838 | 8.85% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | EYEMED VISION CARE | $12 | — | $12 | 0.13% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD, 14TH FLOOR A CHICAGO, IL 60604 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $179 | $69 | $248 | 5.53% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $16 | $10 | $26 | 0.58% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF ILLINOIS EIN 36-1236610 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $2.1M |
| HUB INTERNATIONAL MIDWEST LTD BROKER | Insurance agents and brokers Service code 22 | 55 E JACKSON BLVD CHICAGO, IL 60604 | $537K |
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $418K |
| LIBERTY LIFE ASSURANCE CO OF BOSTON EIN 04-6076039 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $333K |
| DELTA DENTAL OF ILLINOIS EIN 36-2612058 CLAIMS PROCESSING | Claims processing Service code 12 | — | $201K |
| RXBENEFITS EIN 63-1157085 CLAIMS PROCESSING | Claims processing Service code 12 | — | $46K |
| MERCER HEALTH & BENEFITS BROKER | Insurance agents and brokers Service code 22 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | $17K |
| HUB INTERNATIONAL MIDWEST LIMITED EIN 35-0672425 BROKER | Insurance agents and brokers Service code 22 | 55 E JACKSON BLVD CHICAGO, IL 606044466 | $0 |
| MERCER HEALTH & BENEFITS LLC EIN 34-2015463 BROKER | Insurance agents and brokers Service code 22 | 4565 PAYSPHERE CIR CHICAGO, IL 606740045 | $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 | 5,525 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 358 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 5,883 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 1,354 | $7.1M |
| Vision(4 contracts) | EYEMED VISION CARE | 4,316 | $641K |
| Life insurance(2 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 6,945 | $2.0M |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,987 | $856K |
| Other(5 contracts, 4 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 6,945 | $2.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,945 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.