| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FRANK KOPECKY3 | HUB INTERNATIONAL MIDWEST LIMITED 251 PROGRESS WAY, STE 300 WAUNAKEE, WI 53597 | DEAN HEALTH PLAN INC. | $19K | — | $19K | 2.17% |
| MURPHY INSURANCE SERVICES INC3 Filed as: MURPHY INSURANCE SERVICES INC. | 251 PROGRESS WAY, STE 300 WAUNAKEE, WI 53597 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 12.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 251 PROGRESS WAY, STE 300 WAUNAKEE, WI 53597 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $1K | $1K | 1.90% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD. | 251 PROGRESS WAY, STE 300 WAUNAKEE, WI 53597 | UNITED CONCORDIA INSURANCE COMPANY | $5K | $1K | $7K | 11.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 251 PROGRESS WAY, STE 300 WAUNAKEE, WI 53597 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | $2K | — | $2K | 16.00% |
| MURPHY INSURANCE SERVICES INC3 Filed as: MURPHY INSURANCE SERVICES INC. | 251 PROGRESS WAY, STE 300 WAUNAKEE, WI 53597 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $863 | — | $863 | 10.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 251 PROGRESS WAY, STE 300 WAUNAKEE, WI 53597 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $72 | — | $72 | 0.89% |
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 | 138 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | DEAN HEALTH PLAN INC. | 187 | $870K |
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 93 | $61K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC. | 61 | $10K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 138 | $69K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 138 | $61K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 138 | $61K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 138 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 187 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.