| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 3435 WILSHIRE BOULEVARD, SUITE 3000 LOS ANGELES, CA 90010 | UNITEDHEALTHCARE INSURANCE COMPANY | $93K | $0 | $93K | 6.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 6.72% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INSURANCE | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $1K | $4K | 5.83% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS | 422 WAUPONSEE STREET MORRIS, IL 60450 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $316 | $2K | 3.85% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN, INC. | PO BOX 9201 AUSTIN, TX 78766 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $2K | $2K | 3.36% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $572 | $0 | $572 | 0.88% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | PO BOX 9201 AUSTIN, CA 78766 | METROPOLITAN LIFE INSURANCE COMPANY | $10K | $2K | $12K | 24.66% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $976 | $976 | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 600 CORPORATE POINTE, SUITE 600 CULVER CITY, CA 90230 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $45 | $45 | 0.09% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS | 422 WAUPONSEE STREET MORRIS, IL 60450 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $0 | $263 | $263 | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | STARMOUNT LIFE INSURANCE COMPANY | $1K | $0 | $1K | 10.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS | 422 WAUPONSEE STREET MORRIS, IL 60450 | STARMOUNT LIFE INSURANCE COMPANY | $643 | $514 | $1K | 8.99% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN, INC. | PO BOX 9201 AUSTIN, TX 78766 | STARMOUNT LIFE INSURANCE COMPANY | $0 | $643 | $643 | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INSURANCE | 3390 UNIVERSITY AVENUE, SUITE 300 CHICAGO, IL 92501 | STARMOUNT LIFE INSURANCE COMPANY | $0 | $643 | $643 | 5.00% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 36.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INSURANCE | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $71 | $28 | $99 | 3.03% |
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 | 187 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 11 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 203 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 256 | $1.4M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 158 | $62K |
| Vision | STARMOUNT LIFE INSURANCE COMPANY | 126 | $13K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 212 | $68K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 212 | $65K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 212 | $65K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 256 | $1.4M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 212 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 256 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.