| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD 14TH FLOOR CHICAGO, IL 60604 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $138K | — | $138K | 33.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 3635 RIVERSISDE PLAZA DR STE 300 RIVERSIDE, CA 92506 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $36K | — | $36K | 8.57% |
| MARSH & MCLENNAN AGENCY LLC3 | PAYNEWEST INS AN MMA COMPANY PO BOX 85638 SAN DIEGO, CA 921865368 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 1.02% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $592 | $592 | 0.14% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF MT EIN 36-1236610 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $1.3M |
| HEALTHCHECK 360 EIN 42-1403200 NONE | Other services Service code 49 | 800 MAIN STREET PO BOX 1475 DUBUQUE, IA 52004 | $204K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 CLAIMS PROCESSING | Claims processing; Contract Administrator Service code 12 | — | $171K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $133K |
| RXBENEFITS, INC. EIN 63-1157085 CLAIMS PROCESSING | Claims processing Service code 12 | — | $40K |
| COMPSYCH EIN 35-3739783 THIRD PARTY ADMIN | Claims processing Service code 12 | — | $24K |
| HUB INTERNATIONAL MIDWEST LIMITED BROKER | Insurance agents and brokers Service code 22 | 55 E JACKSON BLVD CHICAGO, IL 60604 | $8K |
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 | 3,149 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 84 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,233 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 2,629 | $529K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,149 | $415K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 2,887 | $544K |
| Other(9 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,149 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,149 | — |
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.