| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E. JACKSON BLVD. CHICAGO, IL 60604 | SUN LIFE ASSURANCE COMPANY OF CANADA | $200K | — | $200K | 14.75% |
| STHEALTH BENEFIT SOLUTIONS LLC3 | 18940 N. PIMA RD. SUITE 210 SCOTTSDALE, AZ 85255 | SUN LIFE ASSURANCE COMPANY OF CANADA | $67K | $26K | $93K | 6.84% |
| UMR, INC.3 | 11 SCOTT ST. STE 100 WAUSAU, WI 54403 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $8K | $8K | 0.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E. JACKSON BLVD. CHICAGO, IL 60604 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | — | $5K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E JACKSON BLVD 14TH FLOOR SUITE 14A CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $20K | — | $20K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E JACKSON BLVD 14TH FL SUITE 14A CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $20K | — | $20K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E JACKSON BLVD 14TH FL SUITE 14A CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $11K | — | $11K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 15162 COLLECTION CENTER DRIVE CHICAGO, IL 60693 | VISION SERVICE PLAN | $10K | — | $10K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BLVD. FLOOR 14B CHICAGO, IL 60604 | CONTINENTAL AMERICAN INSURANCE COMPANY | $14K | $0 | $14K | 26.19% |
| ANGELA SCHIEK3 | 953 WILLOW LANE DUNDEE, IL 60118 | CONTINENTAL AMERICAN INSURANCE COMPANY | $594 | $0 | $594 | 1.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E JACKSON BLVD 14TH FL SUITE 14A CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E JACKSON BLVD 14TH FL SUITE 14A CHICAGO, IL 60604 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $385 | — | $385 | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 601 OAKMONT LANE WESTMONT, IL 60599 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $45 | — | $45 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $541K |
| HUB INTERNATIONAL MIDWEST LIMITED EIN 35-0672425 BROKER | Other commissions Service code 55 | — | $61K |
| DELTA DENTAL OF COLORADO EIN 84-0568337 NONE | Contract Administrator Service code 13 | — | $41K |
| RXBENEFITS, INC. EIN 63-1157085 NONE | Contract Administrator; Claims processing Service code 12 | — | $11K |
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 | 1,151 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 17 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,179 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 44 | $310K |
| Vision | VISION SERVICE PLAN | 751 | $97K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,582 | $204K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 965 | $200K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 447 | $108K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | STEALTH PARTNER GROUP | 732 | $2.7M |
| Other(5 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,582 | $290K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,582 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.