| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON CHICAGO, IL 60604 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $18K | $18K | 1.82% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BLVD CHICAGO, IL 60604 | CONTINENTAL AMERICAN INSURANCE COMPANY | $8K | — | $8K | 3.26% |
| KATHLEEN L PLEGER3 | 5320 WHISPERING OAKS PLAINFIELD, IL 60586 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3K | — | $3K | 1.29% |
| JEANNINE M CAPPUSO3 | 8600 HIDDEN RIVER PARKWAY SUITE 75 TAMPA, FL 33637 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3K | — | $3K | 1.21% |
| MICHAEL W DILLON3 | 160 SUGARTREE LANE CASCADE, VA 24069 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3K | — | $3K | 1.03% |
| ANGELA SCHIEK3 | 953 WILLOW LN SLEEPY HOLLOW, IL 60118 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | 0.50% |
| MICHAEL HOWARD WEEKS3 Filed as: MICHAEL H WEEKS | 160 ELLIOTT RD AYDLETT, NC 27916 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | 0.49% |
| CHAD L NELSON3 | 490 EAST ROOSEVELT ROAD SUITE 203 WEST CHICAGO, IL 60185 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | — | $1K | 0.46% |
| PAULA J FAMBROUGH3 | 1201 MAIN STREET SUITE 2300 COLUMBIA, SC 29201 | CONTINENTAL AMERICAN INSURANCE COMPANY | $796 | — | $796 | 0.32% |
| HEYWARD RICHARDSON JR3 Filed as: HEYWARD RICHARDSON | 1163 MCCORDS FERRY RD LUGOFF, SC 29078 | CONTINENTAL AMERICAN INSURANCE COMPANY | $722 | — | $722 | 0.29% |
| LEWIS P GILES3 | 13924 USHWY 29 CHATHAM, VA 24531 | CONTINENTAL AMERICAN INSURANCE COMPANY | $717 | — | $717 | 0.29% |
| TIMOTHY B ASBY3 | 9247 N MERIDIAN ST STE 205 INDIANAPOLIS, IN 46260 | CONTINENTAL AMERICAN INSURANCE COMPANY | $716 | — | $716 | 0.29% |
| RUTH P YOUNG3 | 808 WIGGINGTON RD LYNCHBURG, VA 24502 | CONTINENTAL AMERICAN INSURANCE COMPANY | $698 | — | $698 | 0.28% |
| WILLIAM B POMERANZ3 | 560 LEGACY LAKES WAY ABERDEEN, NC 28315 | CONTINENTAL AMERICAN INSURANCE COMPANY | $446 | — | $446 | 0.18% |
| TERRANCE M LUCZAJ3 | 435 HARRODS LANE CHARLESTON, SC 29412 | CONTINENTAL AMERICAN INSURANCE COMPANY | $336 | — | $336 | 0.13% |
| JODI O PARKER3 | 4947 SOUTH 3000 WEST ROY, UT 84067 | CONTINENTAL AMERICAN INSURANCE COMPANY | $309 | — | $309 | 0.12% |
| DAVID N MORGAN3 | 11520 NUCKOLS ROAD SUITE 103 GLEN ALLEN, VA 23059 | CONTINENTAL AMERICAN INSURANCE COMPANY | $291 | — | $291 | 0.12% |
| SCOTT D MAYER3 | 1440CHATEAU TERRACE MENASHA, WI 54952 | CONTINENTAL AMERICAN INSURANCE COMPANY | $251 | — | $251 | 0.10% |
| JOHN D TYLER3 | 2131 KILEY WAY EDMOND, OK 73034 | CONTINENTAL AMERICAN INSURANCE COMPANY | $250 | — | $250 | 0.10% |
| KHYRSTEN GOSS3 | 2550 OLD ALEX CT. OSHKOSH, WI 54952 | CONTINENTAL AMERICAN INSURANCE COMPANY | $171 | — | $171 | 0.07% |
| DANIEL E ELLIS3 | 349 E CALIFORNIA BLVD PASADENA, CA 91106 | CONTINENTAL AMERICAN INSURANCE COMPANY | $165 | — | $165 | 0.07% |
| CLINT WEIGHT3 | 745 S 180 WEST SALEM, UT 84653 | CONTINENTAL AMERICAN INSURANCE COMPANY | $137 | — | $137 | 0.05% |
| TRACEY H BOURDON3 | 4866 MANDOLIN CT. WINTER HAVEN, FL 33884 | CONTINENTAL AMERICAN INSURANCE COMPANY | $130 | — | $130 | 0.05% |
| ADAM WICHMANN3 | 4362 N BULL RUSH DR APPLETON, WI 54913 | CONTINENTAL AMERICAN INSURANCE COMPANY | $111 | — | $111 | 0.04% |
| HILARY R EBNER3 | 31201 CHICAGO RD S STE A103 WARREN, MI 48093 | CONTINENTAL AMERICAN INSURANCE COMPANY | $109 | — | $109 | 0.04% |
| JENNIFER L FREEMAN3 | 4672CHARING CT CASTLE ROCK, CO 80109 | CONTINENTAL AMERICAN INSURANCE COMPANY | $105 | — | $105 | 0.04% |
| PHILLIP HARRELL3 | 3257 SEREN LAKES WEST END, NC 27376 | CONTINENTAL AMERICAN INSURANCE COMPANY | $96 | — | $96 | 0.04% |
| ALFRED E DEVINE3 | 324 DEVINE WAY SILVER CITY, NC 27344 | CONTINENTAL AMERICAN INSURANCE COMPANY | $83 | — | $83 | 0.03% |
| SUPPLEMENTAL BENEFITS EXCHANGE3 Filed as: SUPPLEMENTAL BENEFITS EXCHANGE AGEN | 580 FOREST AVENUE SUITE 6B PLYMOUTH, MI 48170 | CONTINENTAL AMERICAN INSURANCE COMPANY | $78 | — | $78 | 0.03% |
| JASON P SCZEPANIAK3 | 4001 FELLAND RD SUITE 106 MADISON, WI 53718 | CONTINENTAL AMERICAN INSURANCE COMPANY | $72 | — | $72 | 0.03% |
| STEVEN GIBSON3 | 102 FIRESTONE DRIVE STANLEYTOWN, VA 24168 | CONTINENTAL AMERICAN INSURANCE COMPANY | $69 | — | $69 | 0.03% |
| ASHLEY B BRYANT3 | 6300 E HAMPDEN AVE APT 2213 DENVER, CO 80222 | CONTINENTAL AMERICAN INSURANCE COMPANY | $67 | — | $67 | 0.03% |
| CHAD L NELSON3 | 5266 N KUFALK LANE BYRON, IL 61010 | CONTINENTAL AMERICAN INSURANCE COMPANY | $60 | — | $60 | 0.02% |
| DUANE A ADAMS3 | 11520 NUCKOLS RD STE 103 GLEN ALLEN, VA 23059 | CONTINENTAL AMERICAN INSURANCE COMPANY | $52 | — | $52 | 0.02% |
| AG AND ASSOCIATES3 | 2150 ASSOCIATION DRIVE SUITE 150 OKEMOS, MI 48864 | CONTINENTAL AMERICAN INSURANCE COMPANY | $50 | — | $50 | 0.02% |
| HEIDI E GLAUB3 | 5458 PARKSIDE DRIVE BRIGHTON, MI 48114 | CONTINENTAL AMERICAN INSURANCE COMPANY | $43 | — | $43 | 0.02% |
| JEFFREY LYNN LAMBERT3 Filed as: JEFFREY L LAMBERT | 7 CENTER STREET HINSDALE, IL 60521 | CONTINENTAL AMERICAN INSURANCE COMPANY | $39 | — | $39 | 0.02% |
| MAURICIO R PLATT3 | 4700 LOIRE CT ARGYLE, TX 76226 | CONTINENTAL AMERICAN INSURANCE COMPANY | $38 | — | $38 | 0.02% |
| DAYTON LLC3 | 221 SERENITY DR PICKENS, SC 29671 | CONTINENTAL AMERICAN INSURANCE COMPANY | $31 | — | $31 | 0.01% |
| REGINA K SANTANGELO3 | 9034 E EASTER SUITE 202 CENTENNIAL, CO 80112 | CONTINENTAL AMERICAN INSURANCE COMPANY | $28 | — | $28 | 0.01% |
| GARY W JOHNSON3 | 123 CENTER PARK DRIVE SUITE 123 KNOXVILLE, TN 37922 | CONTINENTAL AMERICAN INSURANCE COMPANY | $27 | — | $27 | 0.01% |
| AMELIA MORGAN3 | 1904 ELLIS DRIVE MAIDENS, VA 23102 | CONTINENTAL AMERICAN INSURANCE COMPANY | $26 | — | $26 | 0.01% |
| MARK A LINSNER3 Filed as: MARK LINSNER | 153 BRANDING BLVD STE 3 ORANGE PARK, FL 32073 | CONTINENTAL AMERICAN INSURANCE COMPANY | $25 | — | $25 | 0.01% |
| BRIMHALL C SUSAN3 | PO BOX 336 SMITHS STATION, AL 36877 | CONTINENTAL AMERICAN INSURANCE COMPANY | $14 | — | $14 | 0.01% |
| JASON E COX3 | 308 S COURT ST MARION, IL 62959 | CONTINENTAL AMERICAN INSURANCE COMPANY | $12 | — | $12 | 0.00% |
| LORRAINE SANCHEZ3 | 318 WITHERS RD DANVILLE, VA 24541 | CONTINENTAL AMERICAN INSURANCE COMPANY | $10 | — | $10 | 0.00% |
| TROY L FALGOUT3 | 503 ESTATE DR NEW IBERIA, LA 70563 | CONTINENTAL AMERICAN INSURANCE COMPANY | $10 | — | $10 | 0.00% |
| ROGERS BENEFIT GROUP INC3 Filed as: DEBORAH L ROGERS, INC | 5668 FISHHAWK CROSSING BLVD #191 LITHIA, FL 33547 | CONTINENTAL AMERICAN INSURANCE COMPANY | $9 | — | $9 | 0.00% |
| JEREMY KOOI3 | 304 W PARKVIEW ST COTTAGE GROVE, WI 53527 | CONTINENTAL AMERICAN INSURANCE COMPANY | $9 | — | $9 | 0.00% |
| SHERRIE ARCENEAUX3 Filed as: SHERRIE D ARCENEAUX | 300 GARFIELD ST LAFAYETTE, LA 70501 | CONTINENTAL AMERICAN INSURANCE COMPANY | $8 | — | $8 | 0.00% |
| NEIL C KNIGHT3 | 4197 NW BITTERSWEET PL CORVALLIS, OR 97330 | CONTINENTAL AMERICAN INSURANCE COMPANY | $7 | — | $7 | 0.00% |
| BARBI HARRINGTON3 | 1110 S FORGOTTEN LN PROVIDENCE, UT 84332 | CONTINENTAL AMERICAN INSURANCE COMPANY | $7 | — | $7 | 0.00% |
| JEREMY S KLOKKENGA3 | 48 PHEASANT TRL GLEN CARBON, IL 62034 | CONTINENTAL AMERICAN INSURANCE COMPANY | $6 | — | $6 | 0.00% |
| JOSE DE LOS SANTOS III3 | 155 INVERENSS DRIVE WEST SUITE 300 ENGLEWOOD, CO 80112 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5 | — | $5 | 0.00% |
| SUSAN C BRIMHALL3 | PO BOX 336 SMITHS STATION, AL 36877 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5 | — | $5 | 0.00% |
| BLAZE J FREMIN3 | 140 RUE BEAUREGARD SUITE C LAFAYETTE, LA 70505 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3 | — | $3 | 0.00% |
| JULIE SLAUGHTER3 | 430 BOARDWA LK WALLED LAKE, MI 48390 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3 | — | $3 | 0.00% |
| HEATHER A DOLLIVER3 | 212 W SILVER LK ROAD FENTON, MI 48430 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3 | — | $3 | 0.00% |
| JEFFREY C WERNER3 | 18096 TRUDY DR SPRING LAKE, MI 49456 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3 | — | $3 | 0.00% |
| LEMUEL E FRANKS3 | 309 E KITTY HAWK DR MIDWEST CITY, OK 73110 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| JANINE FOX3 Filed as: JANINE M FOX | 18 HAVILAND DR. SCHENECTADY, NY 12302 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| MARY REBECCA WEATHERLY3 Filed as: MARY R WEATHERLY | 1934 E LEEWYNN DRIVE SARASOTA, FL 34240 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| JEFF YARISH3 | 16122 ARMISTEAD LN ODESSA, FL 33556 | CONTINENTAL AMERICAN INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| SUWAT ASSAWAMATIYANONT3 Filed as: SUWAT ASSAWAMATIYAN ONT | 1800 NE48TH CT FORT LAUDERDALE, FL 33308 | CONTINENTAL AMERICAN INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL SERVICES INC. | 1091 N SHORELINE BLVD SUITE 200 MOUNTAIN VIEW, CA 94043 | BERKSHIRE LIFE INSURANCE COMPANY OF AMERICA | $15K | — | $15K | 20.77% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Float revenue Service code 12 | — | $739K |
| ANTHEM HEALTH PLANS OF VIRGINIA, IN EIN 54-0357120 NONE | Claims processing; Contract Administrator; Other fees; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $87K |
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 | 1,659 | 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) | 1,659 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 3,435 | $1.6M |
| Dental | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 3,435 | $1.6M |
| Vision | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 3,435 | $1.6M |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,659 | $1.3M |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,659 | $1.0M |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 3,435 | $1.6M |
| Other(3 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,659 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,435 | — |
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."
No prospect flags tripped on this filing.