| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 5314 S YALE, SUITE 900 TULSA, OK 741356257 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $47K | $47K | 3.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL CFR, | 5314 S YALE, SUITE 900 TULSA, OK 74135 | DELTA DENTAL | $9K | — | $9K | 8.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | PO BOX 844501 DALLAS, TX 752844501 | UNUM LIFE INSURANCE CO OF AMERICA | $7K | $610 | $8K | 9.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | PO BOX 844501 DALLAS, TX 752844501 | VISION SERVICE PLAN | $1K | — | $1K | 5.43% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | PO BOX 844501 DALLAS, TX 752844501 | UNUM LIFE INSURANCE CO OF AMERICA | $2K | $80 | $2K | 15.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | HUB INTERNATIONAL CFR TULSA, OK 74135 | COLONIAL LIFE ACCIDENT INSURANCE CO. | $1K | $232 | $2K | 20.16% |
| MARILYN K EMBERSON3 Filed as: MARILYN EMBERSON | 7220 N HAMMOND AVENUE OKLAHOMA CITY, OK 73132 | COLONIAL LIFE ACCIDENT INSURANCE CO. | $677 | $52 | $729 | 9.43% |
| WILLIAM D STAEDKE3 | 25695 E 71ST S BROKEN ARROW, OK 74014 | COLONIAL LIFE ACCIDENT INSURANCE CO. | $496 | $168 | $664 | 8.59% |
| KELLY W PUGH3 | 7367 S 286TH EAST AVE BROKEN ARROW, OK 74014 | COLONIAL LIFE ACCIDENT INSURANCE CO. | $208 | $9 | $217 | 2.81% |
No Schedule C service providers reported on this filing.
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 | 151 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 131 | $1.4M |
| Dental | DELTA DENTAL | 135 | $113K |
| Vision | VISION SERVICE PLAN | 105 | $21K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE CO OF AMERICA | 146 | $100K |
| Short-term disability | COLONIAL LIFE ACCIDENT INSURANCE CO. | 16 | $8K |
| Long-term disability | UNUM LIFE INSURANCE CO OF AMERICA | 146 | $81K |
| Other(2 contracts) | UNUM LIFE INSURANCE CO OF AMERICA | 146 | $92K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 146 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.