| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 16253 COLLECTION CENTER DR CHICAGO, IL 60693 | METROPOLITAN LIFE INSURANCE COMPANY | — | $10K | $10K | 1.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 16253 COLLECTION CENTER DR CHICAGO, IL 60693 | METROPOLITAN LIFE INSURANCE COMPANY | — | $14K | $14K | 2.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | METROPOLITAN LIFE INSURANCE COMPANY | — | $3K | $3K | 0.45% |
| NEBCO5 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | UNITED AMERICAN INS. CO. PRESCRIPTION DRUG PLAN | $9K | — | $9K | 5.58% |
| LAURUS STRATEGIES0 | 55 WEST MONROE STE 500 CHICAGO, IL 60603 | UNITED AMERICAN INS. CO. PRESCRIPTION DRUG PLAN | $5K | — | $5K | 3.27% |
| NEBCO5 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | UNITED AMERICAN INS. CO. MEDICARE SUPPLEMENT | $12K | — | $12K | 14.12% |
| LAURUS STRATEGIES0 | 55 WEST MONROE STE 500 CHICAGO, IL 60603 | UNITED AMERICAN INS. CO. MEDICARE SUPPLEMENT | $3K | — | $3K | 3.53% |
| TBS AGENCY INC3 | 1776 PLEASANT PLAIN RD FAIRFIELD, ID 52556 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | 18.67% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTION AVENUE HARTFORD, CT 06156 | $2.2M |
| EMPATHIA INC EIN 39-1567366 EAP PROVIDER | Other services Service code 49 | N17W24100 RIVERWOOD DRIVE SUITE 300 WAUKESHA, WV 53188 | $196K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $159K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMINISTRATO | Contract Administrator Service code 13 | — | $116K |
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 | 3,997 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 140 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,137 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED AMERICAN INS. CO. MEDICARE SUPPLEMENT | 82 | $86K |
| Vision | VISION SERVICE PLAN | 2,809 | $349K |
| Life insurance(2 contracts) | METROPOLITAN LIFE INSURANCE COMPANY | 6,287 | $844K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 5,195 | $672K |
| Prescription drug | UNITED AMERICAN INS. CO. PRESCRIPTION DRUG PLAN | 81 | $158K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 6,287 | $817K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,287 | — |
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.