| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1591 GALBRAITH AVE SE GRAND RAPIDS, MI 49546 | HARTFORD LIFE AND ACCIDENT | — | $75K | $75K | 4.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | HARTFORD LIFE AND ACCIDENT | $72K | — | $72K | 4.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | 970 RESERVE DR SUITE 200 ROSEVILLE, CA 95678 | HARTFORD LIFE AND ACCIDENT | — | $19K | $19K | 1.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | METROPOLITAN LIFE INSURANCE COMPANY | — | $44 | $44 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | METROPOLITAN LIFE INSURANCE COMPANY | $44K | $2K | $47K | 14.78% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | METROPOLITAN LIFE INSURANCE COMPANY | $12K | $668 | $13K | 13.41% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | METROPOLITAN LIFE INSURANCE COMPANY | $12K | $638 | $13K | 14.54% |
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 | 4,825 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 34 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,859 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 221 | $3.0M |
| Dental(2 contracts) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 5,503 | $5.3M |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 3,078 | $329K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 6,006 | $1.8M |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 6,006 | $1.8M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 6,006 | $1.8M |
| Other(4 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 6,006 | $2.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,006 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.