| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | AMERITAS LIFE INSURANCE CORP. | $7K | $0 | $7K | 10.00% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | AMERITAS LIFE INSURANCE CORP. | $4K | $0 | $4K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 40 EAST ALAMAR AVENUE SANTA BARBARA, CA 93105 | AMERITAS LIFE INSURANCE CORP. | $0 | $3K | $3K | 4.78% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 75 WEST TOWNE RIDGE PARKWAY TOWER 2, SUITE 400 SANDY, UT 84070 | HARTFORD LIFE AND ACCIDENT | $11K | $0 | $11K | 19.88% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | HARTFORD LIFE AND ACCIDENT | $0 | $3K | $3K | 5.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 1591 GALBRAITH AVENUE SE GRAND RAPIDS, MI 49546 | HARTFORD LIFE AND ACCIDENT | $0 | $2K | $2K | 3.88% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | HARTFORD LIFE AND ACCIDENT | $0 | $554 | $554 | 1.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $253 | $0 | $253 | 7.95% |
| DAVE HALL INC4 Filed as: DAVE HALL, INC. | 9748 NORTH CANTERBURY PARK CIRCLE HIGHLAND, UT 84003 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $165 | $0 | $165 | 5.18% |
| ACRISURE LLC4 Filed as: ORION PARKER | 65 NORTH 100 WEST HURRICANE, UT 84737 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $143 | $0 | $143 | 4.49% |
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 | 155 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 155 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AMERITAS LIFE INSURANCE CORP. | 180 | $72K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 180 | $72K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 153 | $53K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 153 | $53K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 153 | $53K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 153 | $57K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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.