| 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 | $176K | $88K | $264K | 14.87% |
| STEALTH PARTNER GROUP LLC3 | 18940 N PIMA ROAD SUITE 210 SCOTTSDALE, AZ 85255 | SUN LIFE ASSURANCE COMPANY OF CANADA | $88K | — | $88K | 4.95% |
| UMR, INC.3 | 11 SCOTT ST STE 100 WAUSAU, WI 54403 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $13K | $13K | 0.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 55 E JACKSON BLVD 14TH FL STE 14A CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $25K | $5K | $30K | 11.82% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 55 E JACKSON BLVD 14TH FL STE 14A CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $17K | $4K | $21K | 12.56% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 55 E JACKSON BLVD 14TH FL STE 14A CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $10K | $3K | $12K | 12.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 15162 COLLECTION CENTER DR CHICAGO, IL 60693 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | — | $9K | 20.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 15162 COLLECTION CENTER DR CHICAGO, IL 60693 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 5.47% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN AND ASSOCIATES LLC | 1800 RTE 34 BLDG 4 WALL TOWNSHIP, NJ 07719 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 3.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 15162 COLLECTION CENTER DR CHICAGO, IL 60693 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | — | $9K | 20.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 15162 COLLECTION CENTER DR CHICAGO, IL 60693 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 6.06% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN AND ASSOCIATES LLC | 1800 RTE 34 BLDG 4 WALL TOWNSHIP, NJ 07719 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 3.80% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 55 E JACKSON BLVD 14TH FL 14A CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $688 | $3K | 12.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 15162 COLLECTION CENTER DR CHICAGO, IL 606930001 | VISION SERVICE PLAN | $579 | — | $579 | 9.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 2800 S RIVER RD STE 130 DES PLAINES, IL 600166087 | VISION SERVICE PLAN | $178 | — | $178 | 3.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIM PROCESSING | Claims processing Service code 12 | — | $598K |
| HUB INTERNATIAONAL MIDWEST LTD EIN 35-0672425 BROKER | Other commissions Service code 55 | ATTN ACCOUNTING 55 E JACKSON BLVD STE 14B CHICAGO, IL 60604 | $61K |
| DELTA DENTAL OF COLORADO EIN 84-0568337 NONE | Contract Administrator Service code 13 | — | $38K |
| RXBENEFITS, INC EIN 63-1157085 CLAIMS PROCESSING | Claims processing Service code 12 | — | $13K |
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 | 855 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 40 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 895 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 387 | $6K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,291 | $251K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 638 | $170K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 321 | $99K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 503 | $1.8M |
| Other(4 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,291 | $369K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,291 | — |
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.