| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 16253 COLLECTION CENTER DR 40 W MADISON 4TH FL BANK OF AMERICA CHICAGO, IL 60693 | METROPOLITAN LIFE INSURANCE COMPANY | — | $20K | $20K | 2.14% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $45K | $45K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 16253 COLLECTION CENTER DR 40 W MADISON 4TH FL BANK OF AMERICA CHICAGO, IL 60693 | METROPOLITAN LIFE INSURANCE COMPANY | — | $18K | $18K | 2.15% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: INSENTIAL INC. D/B/A SOURCE 1 BENE | 206 S JEFFERSON ST STE 200 CHICAGO, IL 606615630 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | — | $8K | 0.90% |
| AMWINS3 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | STONEBRIDGE LIFE INSURANCE | $7K | — | $7K | 5.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E JACKSON BLVD CHICAGO, IL 60604 | STONEBRIDGE LIFE INSURANCE | $4K | — | $4K | 3.26% |
| AMWINS3 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | MONUMENTAL LIFE INSURANCE CO. | $11K | — | $11K | 14.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 EAST JACKSON BLVD CHICAGO, IL 60604 | MONUMENTAL LIFE INSURANCE CO. | $3K | — | $3K | 3.66% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CENTER DRIVE CHICAGO, IL 60693 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $906 | $6K | 9.69% |
| M BARRINGTON CORPORATION3 | 4425 NORTH PORT WASHINGTON RD STE 105 GLENDALE, WI 53212 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $246 | $4K | 7.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | EMPLOYEE BENEFITS DEPARTMENT 55 E JACKSON BLVD CHICAGO, IL 60604 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $2K | $2K | 4.05% |
| M FINANCIAL HOLDINGS INC3 Filed as: M FINANCIAL HOLDINGS INC. | 1125 NW COUCH ST STE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $1K | $1K | 2.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTION AVENUE HARTFORD, CT 06156 | $3.5M |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $326K |
| EMPATHIA INC EIN 39-1567366 EAP PROVIDER | Other services Service code 49 | N17W24100 RIVERWOOD DRIVE SUITE 300 WAUKESHA, WI 53188 | $184K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN. | Contract Administrator Service code 13 | — | $108K |
| HUB INTERNATIONAL BROKER | Insurance agents and brokers Service code 22 | 55 E JACKSON BLVD CHICAGO, IL 60604 | $7K |
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 | 5,955 | 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) | 5,955 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MONUMENTAL LIFE INSURANCE CO. | 68 | $76K |
| Vision | VISION SERVICE PLAN | 2,904 | $493K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 5,955 | $949K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 5,060 | $837K |
| Prescription drug | STONEBRIDGE LIFE INSURANCE | 64 | $136K |
| Stop-loss / reinsurancereinsurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 3,106 | $904K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 5,955 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,955 | — |
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.