| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | EMPLOYEE BENEFITS DEPARATMENT CHICAGO, IL 60604 | AETNA LIFE INSURANCE COMPANY | — | $28K | $28K | 0.48% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 3390 UNIVERSITY AVE., SUITE 300 RIVERSIDE, CA 92501 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $46K | $5K | $50K | 22.33% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R. NELLIGAN & ASSOCIATES | 1060 BROADWAY SUITE 400 ALBANY, NY 12204 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 14 CHICAGO, IL 606044466 | VISION SERVICE PLAN | $6K | — | $6K | 10.80% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWST LIMITED | 1411 OPUS PL STE 450 DOWNERS GROVE, IL 605151423 | VISION SERVICE PLAN | $2K | — | $2K | 3.24% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED BROKER | Other commissions; Insurance agents and brokers Service code 22 | EMPLOYMEE BENEFITS DEPARTMENT 55 E JACKSON BLVD CHICAGO, IL 60604 | $4K |
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 | 1,226 | 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) | 1,226 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 1,356 | $5.7M |
| Dental(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 1,356 | $6.0M |
| Vision | VISION SERVICE PLAN | 649 | $60K |
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,226 | $226K |
| Short-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,226 | $226K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,226 | $226K |
| Other | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,226 | $226K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,356 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.