| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SBR SERVICES LLC3 | 2839 PACES FEE RD SE STE 830 ATLANTA, GA 303395770 | RELIASTAR LIFE INSURANCE COMPANY | — | $140K | $140K | 7.00% |
| UMR, INC.3 Filed as: UMR INC | MARY GOSZ MAIL STOP 7320 11 SCOTT ST STE 100 WAUSAU, WI 544034888 | RELIASTAR LIFE INSURANCE COMPANY | — | $60K | $60K | 3.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SRVCS INC | 6701 CENTER DR W STE 1500 LOS ANGELES, CA 900451561 | RELIASTAR LIFE INSURANCE COMPANY | $54K | — | $54K | 2.71% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 606044466 | KAISER FOUNDATION HEALTH PLAN | $7K | — | $7K | 1.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | HUB INTL MIDWEST LIMITED OPERATING WEST ACCOUNT RIVERSIDE, CA 92516 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $22K | — | $22K | 10.00% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 | 1933 STATE ROUTE 35, SUITE 368 WALL, NJ 07719 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | — | $12K | 5.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | HUB INTL MIDWEST LIMITED OPERATING WEST ACCOUNT RIVERSIDE, CA 92516 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $17K | — | $17K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 14 CHICAGO, IL 606044466 | VISION SERVICE PLAN | $12K | — | $12K | 9.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1411 OPUS PL STE 450 DOWNERS GROVE, IL 605151423 | VISION SERVICE PLAN | $3K | — | $3K | 3.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | HUB INTL MIDWEST LIMITED OPERATING WEST ACCOUNT RIVERSIDE, CA 92516 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | — | $8K | 10.00% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 | 1933 STATE ROUTE 35 SUITE 368 WALL, NJ 07719 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 5.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 15162 COLLECTION CENTER DR CHICAGO, IL 60693 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $12K | — | $12K | 20.00% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN AND ASSOCIATES LLC | 1933 STATE ROUTE 35, SUITE 368 WALL TOWNSHIP, NJ 07719 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 15162 COLLECTION CENTER DR CHICAGO, IL 60693 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 3.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 15162 COLLECTION CENTER DR CHICAGO, IL 60693 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 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 | — | $2K | $2K | 5.58% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN AND ASSOCIATES LLC | 1933 STATE ROUTE 35, SUITE 368 WALL TOWNSHIP, NJ 07719 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | HUB INTL MIDWEST LIMITED OPERATION WEST ACCOUNT RIVERSIDE, CA 92516 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 | 1933 STATE ROUTE 35, SUITE 368 WALL, NJ 077193502 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 5.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | HUB INTL MIDWEST LIMITED OPERATING WEST ACCOUNT RIVERSIDE, CA 92516 | NEW YORK LIFE INSURANCE CO. OF NEW YORK | $841 | — | $841 | 10.00% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 | 1933 STATE ROUTE 35, SUITE 368 WALL, NJ 07719 | NEW YORK LIFE INSURANCE CO. OF NEW YORK | $467 | — | $467 | 5.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD 14TH FL STE 14A CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $58 | — | $58 | 10.80% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIM PROCESSING | Claims processing Service code 12 | — | $546K |
| HUB INTERNATIAONAL MIDWEST LTD EIN 35-0672425 BROKER | Other commissions Service code 55 | ATTN ACCOUNTING 55 E JACKSON BLVD STE 14B CHICAGO, IL 60604 | $64K |
| DELTA DENTAL OF COLORADO EIN 84-0568337 BENEFIT ADMINISTRATOR | Contract Administrator Service code 13 | — | $45K |
| 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 | 769 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 771 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN | 27 | $354K |
| Vision | VISION SERVICE PLAN | 739 | $116K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,188 | $219K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,029 | $165K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 405 | $84K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,227 | $4.0M |
| Other(6 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,188 | $351K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,227 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.