| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD. | 7219 GRAND RIVER RD. BRIGHTON, MI 48114 | AMERITAS LIFE INSURANCE CORP. | $3K | $3K | $6K | 6.70% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | AMERITAS LIFE INSURANCE CORP. | $5K | — | $5K | 6.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD. | 1591 GALBRAITH AVE. SE GRAND RAPIDS, MI 49546 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $3K | $4K | 11.71% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 6.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD. | 1591 GALBRAITH AVE. SE GRAND RAPIDS, MI 49546 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $666 | $940 | $2K | 12.27% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 9.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD. | 1591 GALBRAITH AVE. SE GRAND RAPIDS, MI 49546 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $352 | $669 | $1K | 10.13% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $656 | — | $656 | 6.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD. | 1591 GALBRAITH AVE. SE GRAND RAPIDS, MI 49546 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $519 | $554 | $1K | 14.66% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $945 | — | $945 | 12.92% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD. | 1591 GALBRAITH AVE. SE GRAND RAPIDS, MI 49546 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $570 | $428 | $998 | 14.59% |
| HILB GROUP OF NEW ENGLAND3 | 15400 28TH AVE. NORTH, STE. 200 CRANSTON, RI 02920 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $798 | — | $798 | 11.67% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MICHIGAN EIN 38-2069753 MEDICAL TPA | Insurance services; Claims processing; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Consulting (general); Other fees; Contract Administrator Service code 12 | — | $180K |
| HILB GROUP MIDWEST BROKER | Insurance brokerage commissions and fees; Non-monetary compensation; Other fees; Insurance agents and brokers; Other commissions Service code 22 | 45600 VILLAGE BLVD. SHELBY TOWNSHIP, MI 48315 | $18K |
| GRACE & PORTA BENEFITS INC. BROKER | Insurance agents and brokers; Other commissions; Other fees; Non-monetary compensation; Insurance brokerage commissions and fees Service code 22 | 7219 GRAND RIVER RD. BRIGHTON, MI 48114 | $12K |
| UNITED OF OMAHA LIFE INSURANCE COMP EIN 47-0322111 STD ASO | Contract Administrator; Claims processing Service code 12 | — | $10K |
| HUB INTERNATIONAL MIDWEST LTD. TPA | Other fees; Insurance agents and brokers; Non-monetary compensation; Insurance brokerage commissions and fees; Other commissions Service code 22 | 1591 GALBRAITH AVE. SE GRAND RAPIDS, MI 49546 | $2K |
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 | 228 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 229 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP. | 319 | $86K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 319 | $86K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 228 | $41K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 19 | $13K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF MICHIGAN | 183 | $151K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 228 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 319 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.