| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $74K | $74K | 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 | 1.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD FL 14 CHICAGO, IL 606044466 | METROPOLITAN LIFE INSURANCE COMPANY | — | $55 | $55 | 0.00% |
| 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 | — | $14K | $14K | 1.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD FL 14 CHICAGO, IL 606044466 | METROPOLITAN LIFE INSURANCE COMPANY | — | $55 | $55 | 0.01% |
| AMWINS5 | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | STONEBRIDGE LIFE INSURANCE | $7K | — | $7K | 5.47% |
| HUB INTERNATIONAL MIDWEST LIMITED5 Filed as: HUB INTERNATIONAL MIDWEST LTD | 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. | $10K | — | $10K | 14.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONA MIDWEST LTD | 55 EAST JACKSON BLVD CHICAGO, IL 60604 | MONUMENTAL LIFE INSURANCE CO. | $2K | — | $2K | 3.68% |
| M BARRINGTON CORPORATION3 | 4425 NORTH PORT WASHINGTON RD SUITE 105 GLENDALE, WI 53212 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $3K | $10K | 15.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CTR DR CHICAGO, IL 60693 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $9K | — | $9K | 12.85% |
| 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 | — | $5K | $5K | 8.12% |
| M FINANCIAL HOLDINGS INC3 | 1125 NW COUCH ST STE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $2K | $2K | 2.70% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CTR DR CHICAGO, IL 60693 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $2K | $2K | 2.27% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | 5600 W 83RD ST 8200 TOWER STE 1100 BLOOMINGTON, MN 55437 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $26 | $13 | $39 | 0.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CTR DR CHICAGO, IL 60693 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | — | $5K | 7.98% |
| M BARRINGTON CORPORATION3 | 4425 NORTH PORT WASHINGTON RD SUITE 105 GLENDALE, WI 53212 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $363 | $4K | 6.99% |
| 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 | — | $2K | $2K | 2.96% |
| M FINANCIAL HOLDINGS INC3 | 1125 NW COUCH ST STE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $1K | $1K | 2.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CTR DR CHICAGO, IL 60693 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $867 | $867 | 1.42% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTION AVENUE HARTFORD, CT 06156 | $2.7M |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $277K |
| EMPATHIA INC EIN 39-1567366 EAP PROVIDER | Other services Service code 49 | N17W24100 RIVERWOOD DRIVE SUITE 300 WAUKESHA, WI 53188 | $182K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN. | Contract Administrator Service code 13 | — | $115K |
| HUB INTERNATIONAL BROKER | Insurance agents and brokers Service code 22 | 55 E JACKSON BLVD CHICAGO, IL 60604 | $2K |
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 | 5,875 | 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) | 5,875 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MONUMENTAL LIFE INSURANCE CO. | 60 | $67K |
| Vision | VISION SERVICE PLAN | 2,930 | $495K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 5,875 | $944K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 5,051 | $1.4M |
| Prescription drug | STONEBRIDGE LIFE INSURANCE | 56 | $126K |
| Stop-loss / reinsurancereinsurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 3,141 | $1.5M |
| Other(3 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 5,875 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,875 | — |
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.