| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 55 WEST MONROE SUITE 500 CHICAGO, IL 60603 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $11K | $17K | 2.68% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 55 WEST MONROE SUITE 500 CHICAGO, IL 60603 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $7K | $16K | 3.59% |
| FLEXVISION - MD3 | 15400 CALHOUN DR SUITE 125 ROCKVILLE, MD 20855 | EYEMED VISION CARE | $5K | — | $5K | 2.16% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 55 WEST MONROE SUITE 500 CHICAGO, IL 60603 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $2K | $7K | 6.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 55 WEST MONROE SUITE 500 CHICAGO, IL 60603 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $0 | $309 | $309 | 3.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK BCBS PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 120 FIFTH AVE PITTSBURGH, PA 20155 | $1.9M |
| FLEX VISION - MD BROKER | Insurance agents and brokers Service code 22 | 15400 CALHOUN DR. STE 125 ROCKVILLE, MD 20855 | $0 |
| HUB INTERNATIONAL INSURANCE SERVICE CONSULTANT | Consulting (general) Service code 16 | 3390 UNIVERSITY AVE #300 RIVERSIDE, CA 92501 | $0 |
| HUB INTERNATIONAL MIDWEST CONSULTANT | Consulting (general) Service code 16 | 55 WEST MONROE STE 500 CHICAGO, IL 60603 | $0 |
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 | 4,207 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 20 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 4,227 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF VIRGINIA | 3,566 | $2.2M |
| Vision | EYEMED VISION CARE | 2,783 | $244K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,912 | $765K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,406 | $442K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,912 | $127K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,566 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.