| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL GREAT PLAINS, LLC | 11516 MIRACLE HILLS DR STE 100 OMAHA, NE 68154 | HARTFORD LIFE AND ACCIDENT | $3K | — | $3K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTL MIDWEST LIMITED | 1591 GALBRAITH AVE SE GRAND RAPIDS, MI 49546 | HARTFORD LIFE AND ACCIDENT | — | $1K | $1K | 5.41% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 NONE | Claims processing Service code 12 | — | $28K |
| FORVIS MAZARS, LLP EIN 44-0160260 NONE | Accounting (including auditing) Service code 10 | — | $23K |
| KUTAK ROCK LLP NONE | Legal Service code 29 | 1650 FARNAM STREET OMAHA, NE 68102 | $20K |
| SILVERSTONE GROUP INCORPORATED EIN 47-0813106 NONE | Other commissions Service code 55 | — | $15K |
| CELESTE GARDNER EIN 47-6062771 RELATED PLAN EE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $6K |
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 | 0 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 94 | $25K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 94 | $25K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 89 | $407K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 94 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.